Department of Breast Surgery, Beaumont Hospital, Dublin and Department of Surgery, Royal College of Surgeons, Dublin, Ireland.
Department of Breast Surgery, Beaumont Hospital, Dublin and Department of Surgery, Royal College of Surgeons, Dublin, Ireland.
Clin Breast Cancer. 2022 Oct;22(7):699-704. doi: 10.1016/j.clbc.2022.05.009. Epub 2022 Jun 2.
B3 lesions are a heterogeneous group of breast lesions of uncertain malignant potential which usually require excision. The aim was to assess the efficacy of 5 years routine radiological or clinical follow-up of patients who had "high-risk" B3 lesions surgically excised, by analyzing recurrence and subsequent development of invasive/in-situ cancer.
A 10-year retrospective review from 2010 to 2019 was performed of B3 lesions diagnosed on core needle biopsy, including patients who proceeded to surgical excision with a high-risk lesion on final histology. The database recorded 6 specific B3 lesion categories: 1. Atypical ductal hyperplasia (ADH), 2. Radial scars/complex sclerosing lesions (CSLs) with epithelial atypia 3. Classical Lobular neoplasia (ALH/LCIS), 4. Papillary lesions with epithelial atypia, 5. Mixed, 6. Flat epithelial atypia (FEA), including radiological and clinical follow-up data.
Six hundred sixteen patients had a B3 lesion after core biopsy. 110 patients had "high risk" lesions. This included 17 (15.5%) Atypical Ductal Hyperplasia (ADH), 22 (20%) radial scars/CSLs with epithelial atypia, 47 (42.7%) classical lobular neoplasia (LCIS/ALH), 7 (6.4%) papillary lesions with epithelial atypia, 13 (11.8%) mixed lesions & 4 (3.6%) Flat Epithelial Atypia (FEA) lesions. 4 of 110 (3.6%) developed invasive/in-situ disease and 4 of 110 (3.6%) developed recurrence during follow-up. 33 of 616 (5.4%) upgraded to invasive/preinvasive disease after surgical excision.
Five years of routine radiological surveillance may not be necessary in patients who undergo surgical excision of "high-risk" B3 lesions. Clinical surveillance appears to be of little benefit, especially in patients with radial scars, papillary lesions, and FEA. Subsequent development of invasive/in-situ disease in patients who undergo surgical excision of atypical B3 lesions remains low.
B3 病变是一组具有不确定恶性潜能的乳腺病变，通常需要切除。目的是通过分析复发和随后发生的浸润性/原位癌来评估对手术切除“高危”B3 病变的患者进行 5 年常规放射学或临床随访的疗效。
对 2010 年至 2019 年的 B3 病变进行了 10 年回顾性研究，包括最终组织学检查显示高危病变的患者进行手术切除。数据库记录了 6 种特定的 B3 病变类型：1. 非典型导管增生（ADH），2. 放射状瘢痕/伴有上皮不典型性的复杂硬化性病变（CSL），3. 经典小叶肿瘤（ALH/LCIS），4. 伴有上皮不典型性的乳头状病变，5. 混合性，6. 扁平上皮不典型性（FEA），包括放射学和临床随访数据。
在核心针活检后，616 例患者出现 B3 病变。110 例患者有“高危”病变。这包括 17 例（15.5%）非典型导管增生（ADH），22 例（20%）放射状瘢痕/伴有上皮不典型性的 CSL，47 例（42.7%）经典小叶肿瘤（LCIS/ALH），7 例（6.4%）伴有上皮不典型性的乳头状病变，13 例（11.8%）混合性病变和 4 例（3.6%）扁平上皮不典型性（FEA）病变。在随访期间，有 4 例（3.6%）出现浸润性/原位疾病，有 4 例（3.6%）出现复发。616 例患者中有 33 例（5.4%）在手术切除后升级为浸润性/前病变。
对于“高危”B3 病变行手术切除的患者，5 年常规放射学监测可能不是必需的。临床监测似乎没有什么好处，特别是对于放射状瘢痕、乳头状病变和 FEA 的患者。在手术切除非典型 B3 病变的患者中，随后发生浸润性/原位疾病的发生率仍然较低。
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