He Ping, Lei Yu-Tao, Zhao Hong-Mei, Chen Wen, Shen Wei-Wei, Fu Peng, Cui Li-Gang
Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China.
Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China.
World J Surg. 2023 May;47(5):1247-1252. doi: 10.1007/s00268-023-06930-9. Epub 2023 Feb 8.
The aim of this study was to analyze the role of ultrasound-guided vacuum-assisted excision (US-guided VAE) in the treatment of high-risk breast lesions and to evaluate the clinical and US features of the patients associated with recurrence or development of malignancy.
Between April 2010 and September 2021, 73 lesions of 73 patients underwent US-guided VAE and were diagnosed with high-risk breast lesions. The incidence of recurrence or development of malignancy for high-risk breast lesions was evaluated at follow-up period. The clinical and US features of the patients were analyzed to identify the factors affecting the recurrence or development of malignancy rate.
Only benign phyllodes tumors on US-guided VAE showed recurrences, while other high-risk breast lesions that were atypical ductal hyperplasia (ADH), lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ), radial scar, and flat epithelial atypia did not show recurrences or malignant transformation. The recurrence rate of the benign phyllodes tumor was 20.8% (5/24) in a mean follow-up period of 34.3 months. The recurrence rate of benign phyllodes tumor with distance from nipple of less than 1 cm was significantly higher than that of lesions with distance from nipple of more than 1 cm (75% vs. 10%, p < 0.05).
Benign phyllodes tumors without concurrent breast cancer could be safely followed up instead of surgical excision after US-guided VAE when the lesions were classified as BI-RADS 3 or 4A by US.
本研究旨在分析超声引导下真空辅助切除（US引导下VAE）在高危乳腺病变治疗中的作用，并评估与复发或恶性肿瘤发生相关的患者临床及超声特征。
2010年4月至2021年9月期间，73例患者的73个病变接受了US引导下VAE，并被诊断为高危乳腺病变。在随访期评估高危乳腺病变复发或发生恶性肿瘤的发生率。分析患者的临床及超声特征，以确定影响恶性肿瘤复发率或发生率的因素。
US引导下VAE中仅良性叶状肿瘤出现复发，而其他高危乳腺病变，即非典型导管增生（ADH）、小叶瘤变（非典型小叶增生/小叶原位癌）、放射状瘢痕和平坦上皮异型增生均未出现复发或恶变。良性叶状肿瘤在平均34.3个月的随访期内复发率为20.8%（5/24）。距乳头距离小于1 cm的良性叶状肿瘤复发率显著高于距乳头距离大于1 cm的病变（75%对10%，p<0.05）。
当病变经超声分类为BI-RADS 3或4A时，对于无合并乳腺癌的良性叶状肿瘤，在US引导下VAE后可安全随访而非手术切除。
