Botta G, Cerrato G, Corongiu F
Ann Osp Maria Vittoria Torino. 1980 Jul-Dec;23(7-12):435-46.
Lobular Neoplasia of the breast, a term which we prefer to that of Lobular Carcinoma in Situ, is a multifocal microscopic entity of uncertain and controversial clinical significance. Lobular Neoplasia is a incidental histological finding among otherwise benign breast biopsies (0.5%-3.5%) depending mainly upon the diagnostic intensity. Its extent is rarely so massive that it makes up a palpable tumor. Although this lesion may be demonstrated at all ages after puberty it occurs most often in premenopausal women. The multicentricity is not below 70% and bilateral occurrence not below 30-35%. Demonstration of Lobular Carcinoma in situ means a 7-12 times greater risk of later developing invasive breast carcinoma as compared with an age corrected general population. Both breast are at risk and about one half of these subsequent carcinomas will develop in the controlateral breast. Attempts at correlating the histological appearances in Lobular Neoplasia with the subsequent occurrence of invasive breast carcinoma have generally be negative. From this data it appears that ipsilateral mastectomy will protect only one half of women with lobular neoplasia who will eventually develop carcinoma and the only surgical approach would perform a bilateral mastectomy. As an alternative to mastectomy, a careful program of frequent follow-up examinations, when possible is preferable.
乳腺小叶瘤变是一个我们更倾向于使用的术语，相较于小叶原位癌，它是一种多灶性的微观病变，其临床意义尚不明确且存在争议。小叶瘤变是在其他方面为良性的乳腺活检中偶然发现的组织学表现（0.5%-3.5%），主要取决于诊断的仔细程度。其范围很少会大到形成可触及的肿瘤。尽管这种病变在青春期后的所有年龄段都可能出现，但最常见于绝经前女性。多中心发生率不低于70%，双侧发生率不低于30%-35%。小叶原位癌的存在意味着与年龄校正后的普通人群相比，日后发生浸润性乳腺癌的风险高出7至12倍。双侧乳房都有风险，并且这些后续发生的癌症中约有一半会出现在对侧乳房。试图将小叶瘤变的组织学表现与随后发生的浸润性乳腺癌相关联的研究通常都没有得到肯定结果。从这些数据来看，同侧乳房切除术只能保护最终会发生癌变女性中的一半，而唯一的手术方法是双侧乳房切除术。作为乳房切除术的替代方法，尽可能进行仔细的定期随访检查计划更为可取。
