This retrospective study investigates the histopathological outcomes, upgrade rates, and disease-free survival (DFS) of high-risk breast lesions, including atypical ductal hyperplasia (ADH or DIN1b) and lobular in situ neoplasms (LIN), following Vacuum-Assisted Breast Biopsy (VABB) and surgical excision. The study addresses the challenge posed by these lesions due to their association with synchronous or adjacent Breast Cancer (BC) and increased future BC risk. The research, comprising 320 patients who underwent stereotactic VABB, focuses on 246 individuals with a diagnosis of ADH (120) or LIN (126) observed at follow-up. Pathological assessments, categorized by the UK B-coding system, were conducted, and biopsy samples were compared with corresponding excision specimens to determine upgrade rates for in situ or invasive carcinoma. Surgical excision was consistently performed for diagnosed ADH or LIN. Finally, patient follow-ups were assessed and compared between LIN and ADH groups to identify recurrence signs, defined as histologically confirmed breast lesions on either the same or opposite side. The results reveal that 176 (71.5%) patients showed no upgrade post-surgery, with ADH exhibiting a higher upgrade rate to in situ pathology than LIN1 (Atypical Lobular Hyperplasia, ALH)/LIN2 (Low-Grade Lobular in situ Carcinoma, LCIS) (38% vs. 20%, respectively,p-value = 0.002). Considering only patients without upgrade, DFS at 10 years was 77%, 64%, and 72% for ADH, LIN1, and LIN2 patients, respectively (p-value = 0.92). The study underscores the importance of a multidisciplinary approach, recognizing the evolving role of VABB. It emphasizes the need for careful follow-up, particularly for lobular lesions, offering valuable insights for clinicians navigating the complex landscape of high-risk breast lesions. The findings advocate for heightened awareness and vigilance in managing these lesions, contributing to the ongoing refinement of clinical strategies in BC care.
本回顾性研究探讨了经真空辅助乳腺活检（VABB）及手术切除后，高风险乳腺病变（包括非典型导管增生（ADH或DIN1b）和小叶原位肿瘤（LIN））的组织病理学结果、升级率及无病生存期（DFS）。这些病变因与同步或邻近乳腺癌（BC）相关且增加未来BC风险而构成临床挑战。研究纳入320例接受立体定向VABB的患者，重点关注随访中确诊为ADH（120例）或LIN（126例）的246例个体。采用英国B编码系统进行病理评估，通过对比活检样本与对应切除标本，确定原位癌或浸润性癌的升级率。所有确诊ADH或LIN病例均接受手术切除。最后对LIN与ADH组患者进行随访评估比较，以发现复发迹象（定义为同侧或对侧经组织学证实的乳腺病变）。结果显示：176例（71.5%）患者术后未出现病理升级，ADH组向原位病理升级的比例显著高于LIN1（非典型小叶增生，ALH）/LIN2（低级别小叶原位癌，LCIS）组（38% vs. 20%，p=0.002）。在未升级患者中，ADH、LIN1和LIN2患者的10年DFS分别为77%、64%和72%（p=0.92）。本研究强调了多学科诊疗模式的重要性，并指出VABB技术不断演进的临床价值。研究结果特别提示对小叶病变需加强随访监测，为临床医生处理高风险乳腺病变的复杂情况提供了重要参考。这些发现主张在管理此类病变时需提高警惕性，有助于持续优化乳腺癌临床诊疗策略。
肿瘤(癌症)患者之家