Bodian C A, Perzin K H, Lattes R
Department of Biomathematical Sciences, Mount Sinai Medical Center, New York, New York 10029, USA.
Cancer. 1996 Sep 1;78(5):1024-34. doi: 10.1002/(SICI)1097-0142(19960901)78:5<1024::AID-CNCR12>3.0.CO;2-4.
Lobular neoplasia (LN), also known as lobular carcinoma in situ, is an incidental histologic finding in tissue removed at breast surgery. Patients with LN are known to be predisposed to develop invasive or intraductal carcinoma (CA). This study investigates factors that influence the cancer risk in LN patients.
Analysis of data concerning long term follow-up (median: 18 yrs) of 236 patients with LN identified in a pathologic review of more than 2000 biopsy specimens with benign epithelial proliferative breast disease.
The probability of CA developing in either breast in long term survivors after a biopsy that contained LN was approximately 1/3, which is 5.4 times (95% CI: 4.2 - 7.0) the rate in the general population. The relative risk (RR) tended to decrease with increasing age at diagnosis, but was approximately doubled (RR: 1.8; 95% CI: 1.1-3.2) for patients with benign epithelial breast disease preceding their initial diagnosis of LN. CA risk remained markedly elevated for at least 20 years, and increased substantially if there was a second operation showing LN- from 4.9 (95% CI: 3.7-6.4) after a single operation with LN to 16.1 (95% CI: 6.9-31.8) after a second such operation.
LN is a marker of increased CA risk that is further exacerbated by episodes of preexisting benign breast epithelial proliferative changes, and that remains substantially elevated for many years.
小叶瘤变（LN），也称为小叶原位癌，是在乳腺手术切除组织中偶然发现的组织学表现。已知LN患者易发生浸润性或导管内癌（CA）。本研究调查影响LN患者癌症风险的因素。
对2000多份患有良性上皮增生性乳腺疾病的活检标本进行病理检查，确定了236例LN患者的长期随访数据（中位数：18年）并进行分析。
活检发现有LN的长期存活者中，双侧乳腺发生CA的概率约为1/3，是普通人群发生率的5.4倍（95%可信区间：4.2 - 7.0）。相对风险（RR）倾向于随诊断时年龄增加而降低，但最初诊断为LN之前患有良性上皮性乳腺疾病的患者相对风险约增加一倍（RR：1.8；95%可信区间：1.1 - 3.2）。CA风险至少20年一直显著升高，如果二次手术发现LN，风险会大幅增加——单次手术发现LN后风险为4.9（95%可信区间：3.7 - 6.4），二次手术发现LN后风险为16.1（95%可信区间：6.9 - 31.8）。
LN是CA风险增加的一个标志物，既往存在的良性乳腺上皮增生性改变会进一步加剧这种风险，且这种风险会在许多年内持续大幅升高。
