High-risk breast lesions including incidental intraductal papilloma without atypia (IPA), lobular hyperplasia (LCIS or ALH), flat epithelial atypia (FEA) and complex sclerosing lesion (CSL) are not routinely excised due to low upgrade rates to carcinoma. We aim to identify features of these lesions predictive of upgrade when identified concurrently with invasive disease. Methods: A single-center retrospective cohort study was performed for patients who underwent multi-site lumpectomies with invasive disease at one site and a high-risk lesion at another site between 2006 and 2021. A multinomial logistic regression was performed. Results: Sixty-five patients met the inclusion criteria. Four patients (6.2%) had an upgrade to in situ disease (DCIS) and one (1.5%) to invasive carcinoma. Three upgraded high-risk lesions were ipsilateral to the concurrent carcinoma and two were contralateral. In the multivariate model, a high-risk lesion within 5 cm of an ipsilateral malignancy was associated with increased risk of upgrade. The 3.8% upgrade rate for high-risk lesions located greater than 5 cm from ipsilateral malignancy or in the contralateral breast suggests that omission of excisional biopsy may be considered. Excisional biopsy of lesions within 5 cm of ipsilateral malignancy is recommended given the 25% upgrade risk in our series.
高风险乳腺病变，包括非典型性导管内乳头状瘤（IPA）、小叶增生（LCIS或ALH）、平坦上皮非典型性（FEA）以及复杂性硬化性病变（CSL），因其恶变升级率较低，通常不进行常规切除。本研究旨在识别当这些病变与浸润性疾病同时存在时，能够预测其升级的特征。方法：对2006年至2021年间在一家中心接受多部位肿块切除术的患者进行了一项回顾性队列研究，这些患者在一个部位存在浸润性疾病，而在另一部位存在高风险病变。研究采用了多项逻辑回归分析。结果：共有65名患者符合纳入标准。其中4名患者（6.2%）的病变升级为原位癌（DCIS），1名患者（1.5%）升级为浸润性癌。在升级的高风险病变中，三例与同时存在的癌灶同侧，两例位于对侧。在多变量模型中，高风险病变位于同侧恶性肿瘤5厘米范围内与升级风险增加相关。对于距离同侧恶性肿瘤超过5厘米或位于对侧乳腺的高风险病变，其升级率为3.8%，这表明可以考虑省略切除活检。鉴于本研究中位于同侧恶性肿瘤5厘米范围内的病变升级风险为25%，建议对此类病变进行切除活检。
肿瘤(癌症)患者之家