Noorbakhsh Seth, Koenig Zachary A, Hewitt Noah, Climov Mihail, Hazard-Jenkins Hannah, Flanagan Melina, Woodberry Kerri
West Virginia University School of Medicine.
West Virginia University School of Medicine Division of Plastic Surgery †West Virginia University Cancer Institute.
Plast Reconstr Surg Glob Open. 2022 Feb 22;10(2):e4141. doi: 10.1097/GOX.0000000000004141. eCollection 2022 Feb.
Atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH) of the breast are premalignant lesions. Although the literature on ADH and ALH as a whole is well-developed, research on ADH and ALH incidentally discovered during breast reduction is less robust.
In this study, 355 patients undergoing bilateral reduction mammoplasty at West Virginia University were retrospectively reviewed. A variety of demographic and clinicopathologic variables were collected for each patient, and the incidence of atypical hyperplasia was calculated. Four patients (1.13%) were found to have atypical hyperplasia, three ALH, and one ADH, which is within the range reported in the literature. For patients incidentally found to have atypical hyperplasia, an in-depth analysis of postoperative management was performed.
Of the four patients with atypical hyperplasia, three were referred to a cancer center, and one patient followed only with plastic surgery. The three patients who were referred to a cancer center saw a breast surgeon, whereas the patient followed only by plastic surgery did not. None of the four patients received anti-estrogen therapy, but each patient who followed with a cancer center was offered treatment and declined.
As a relatively uncommon finding with complex management guidelines, atypical hyperplasia discovered on breast reduction should be referred to a cancer center for long-term follow-up and management when possible. Further research is needed to assess if the management of atypical hyperplasia discovered incidentally after routine reduction should mimic treatment of atypical hyperplasia found after biopsy for suspicion of malignancy.
乳腺不典型导管增生（ADH）和不典型小叶增生（ALH）是癌前病变。尽管关于ADH和ALH的整体文献很丰富，但对在缩乳术中偶然发现的ADH和ALH的研究较少。
在本研究中，对西弗吉尼亚大学355例行双侧缩乳术的患者进行回顾性分析。收集每位患者的各种人口统计学和临床病理变量，并计算不典型增生的发生率。4例患者（1.13%）被发现有不典型增生，3例为ALH，1例为ADH，这在文献报道的范围内。对于偶然发现有不典型增生的患者，对术后管理进行了深入分析。
在4例有不典型增生的患者中，3例被转诊至癌症中心，1例仅接受整形手术随访。转诊至癌症中心的3例患者看了乳腺外科医生，而仅接受整形手术随访的患者未看。4例患者均未接受抗雌激素治疗，但每个在癌症中心随访的患者都被提供了治疗并拒绝。
作为一种相对少见且管理指南复杂的情况，缩乳术中发现的不典型增生应尽可能转诊至癌症中心进行长期随访和管理。需要进一步研究以评估常规缩乳术后偶然发现的不典型增生的管理是否应模仿活检怀疑恶性肿瘤后发现的不典型增生的治疗。
