乳腺高危病变的乳腺X线诊断及技术进展
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摘要
乳腺高危病变包括良性病变及原位癌,具有发生乳腺癌的风险。高危病变首诊主要依赖于穿刺活检,但首诊后存在一定的病变升级率。对于不同的高危病变,如不典型导管增生(ADH)、乳头状瘤伴不典型增生、放射状瘢痕、小叶原位癌(LCIS)、不典型小叶增生(ALH)、黏液囊肿样病变、平坦上皮非典型增生等,乳腺X线检查的诊断及处理原则并不完全相同。就乳腺X线检查对高危病变的诊断、处理、预后评估的研究进展予以综述。
High-risk lesions of breast include some benign lesions and carcinoma in situ, and have an increased risk of developing breast cancer. The initial diagnosis of high-risk lesions mainly relies on core needle biopsy, but the lesions can be aggravated after initial diagnosis. For differentiating high-risk lesions, such as atypical ductal hyperplasia, papilloma with atypical hyperplasia, radial scar, lobular carcinoma in situ, atypical lobular hyperplasia, mucinous cystoid lesions, and flat epithelial atypical hyperplasia, the mammographic diagnoses and treatment strategies are not completely the same. This review summarizes the progress of the diagnosis, management and prognosis evaluation of high-risk lesions using mammography.
High-risk lesions of breast include some benign lesions and carcinoma in situ, and have an increased risk of developing breast cancer. The initial diagnosis of high-risk lesions mainly relies on core needle biopsy, but the lesions can be aggravated after initial diagnosis. For differentiating high-risk lesions, such as atypical ductal hyperplasia, papilloma with atypical hyperplasia, radial scar, lobular carcinoma in situ, atypical lobular hyperplasia, mucinous cystoid lesions, and flat epithelial atypical hyperplasia, the mammographic diagnoses and treatment strategies are not completely the same. This review summarizes the progress of the diagnosis, management and prognosis evaluation of high-risk lesions using mammography.
引文
[1]Collins LC,Aroner SA,Connolly JL,et al.Breast cancer risk by extent and type of atypical hyperplasia:an update from the Nurses’Health Studies[J].Cancer,2016,122:515-520.
[2]Hartmann LC,Sellers TA,Frost MH,et al.Benign breast disease and the risk of breast cancer[J].N Engl J Med,2005,353:229-237.
[3]Uzoaru I,Morgan BR,Liu ZG,et al.Flat epithelial atypia with and without atypical ductal hyperplasia:to re-excise or not.Results of a5-year prospective study[J].Virchows Arch,2012,461:419-423.
[4]Georgian-Smith D,Lawton TJ.Controversies on the management of high-risk lesions at core biopsy from a radiology/pathology perspective[J].Radiol Clin North Am,2010,48:999-1012.
[5]Berg WA.Image-guided breast biopsy and management of high-risk lesions[J].Radiol Clin North Am,2004,42:935-946.
[6]Burbank F.Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions:improved accuracy with directional,vacuum-assisted biopsy[J].Radiology,1997,202:843-847.
[7]Londero V,Zuiani C,Linda A,et al.Lobular neoplasia:core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features[J].Breast,2008,17:623-630.
[8]Lopez-Medina A,Cintora E,Mugica B,et al.Radial scars diagnosed at stereotactic core-needle biopsy:surgical biopsy findings[J].Eur Radiol,2006,16:1803-1810.
[9]Mesurolle B,Perez JC,Azzumea F,et al.Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy:frequency,final surgical outcome,and factors associated with underestimation[J].AJR,2014,202:1389-1394.
[10]Sen LQ,Berg WA,Hooley RJ,et al.Core breast biopsies showing lobular carcinoma in situ should be excised and surveillance is reasonable for atypical lobular hyperplasia[J].AJR,2016,207:1132-1145.
[11]Rageth CJ,O'Flynn EA,Comstock C,et al.First international consensus conference on lesions of uncertain malignant potential in the breast(B3 lesions)[J].Breast Cancer Res Treat,2016,159:203-213.
[12]Mooney KL,Bassett LW,Apple SK.Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy:a single-institution experience and literature review[J].Mod Pathol,2016,29:1471-1484.
[13]Morrow M,Schnitt SJ,Norton L.Current management of lesions associated with an increased risk of breast cancer[J].Nat Rev Clin Oncol,2015,12:227-238.
[14]Linda A,Zuiani C,Furlan A,et al.Nonsurgical management of high-risk lesions diagnosed at core needle biopsy:can malignancy be ruled out safely with breast MRI[J].AJR,2012,198:272-280.
[15]Krishnamurthy S,Bevers T,Kuerer HM,et al.Paradigm shifts in breast care delivery:impact of imaging in a multidisciplinary environment[J].AJR,2017,208:248-255.
[16]Bednarova I,Londero V,Linda A,et al.Do clinical and radiologic features help predict malignancy of B3 breast lesions without epithelial atypia(B3a)[J].Radiol Med,2018,123:809-817
[17]Kader T,Hill P,Rakha EA,et al.Atypical ductal hyperplasia:update on diagnosis,management,and molecular landscape[J].Breast Cancer Res,2018,20:39.
[18]Zeinomar N,Phillips KA,Daly MB,et al.Benign breast disease increases breast cancer risk independent of underlying familial risk profile:findings from a prospective family study cohort[J].Int J Cancer,2019.DOI:10.1002/ijc.32112.
[19]Degnim AC,Dupont WD,Radisky DC,et al.Extent of atypical hyperplasia stratifies breast cancer risk in 2 independent cohorts of women[J].Cancer,2016,122:2971-2978.
[20]Middleton LP,Sneige N,Coyne R,et al.Most lobular carcinoma in situ and atypical lobular hyperplasia diagnosed on core needle biopsy can be managed clinically with radiologic follow-up in a multidisciplinary setting[J].Cancer Med,2014,3:492-499.
[21]Wen X,Cheng W.Nonmalignant breast papillary lesions at coreneedle biopsy:a meta-analysis of underestimation and influencing factors[J].Ann Surg Oncol,2013,20:94-101.
[22]Cuneo KC,Dash RC,Wilke LG,et al.Risk of invasive breast cancer and ductal carcinoma in situ in women with atypical papillary lesions of the breast[J].Breast J,2012,18:475-478.
[23]Eiada R,Chong J,Kulkarni S,et al.Papillary lesions of the breast:MRI,ultrasound,and mammographic appearances[J].AJR,2012,198:264-271.
[24]Wang J,Yang X,Cai H,et al.Discrimination of breast cancer with microcalcifications on mammography by deep learning[J].Sci Rep,2016,6:27327.
[25]Cohen MA,Newell MS.Radial scars of the breast encountered at core biopsy:review of histologic,imaging,and management considerations[J].AJR,2017,209:1168-1177.
[26]柳杰,刘佩芳.数字乳腺断层摄影在乳腺筛查中的应用进展[J].国际医学放射学杂志,2018,41:319-323.
[27]Sharpe RJ,Venkataraman S,Phillips J,et al.Increased cancer detection rate and variations in the recall rate resulting from implementation of 3D digital breast tomosynthesis into a populationbased screening program[J].Radiology,2016,278:698-706.
[28]Skaane P,Bandos AI,Gullien R,et al.Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program[J].Radiology,2013,267:47-56.
[29]Lamb LR,Bahl M,Hughes KS,et al.Pathologic upgrade rates of high-risk breast lesions on digital two-dimensional vs tomosynthesis mammography[J].J Am Coll Surg,2018,226:858-867.
[30]Bahl M,Barzilay R,Yedidia AB,et al.High-risk breast lesions:a machine learning model to predict pathologic upgrade and reduce unnecessary surgical excision[J].Radiology,2018,286:810-818.
[2]Hartmann LC,Sellers TA,Frost MH,et al.Benign breast disease and the risk of breast cancer[J].N Engl J Med,2005,353:229-237.
[3]Uzoaru I,Morgan BR,Liu ZG,et al.Flat epithelial atypia with and without atypical ductal hyperplasia:to re-excise or not.Results of a5-year prospective study[J].Virchows Arch,2012,461:419-423.
[4]Georgian-Smith D,Lawton TJ.Controversies on the management of high-risk lesions at core biopsy from a radiology/pathology perspective[J].Radiol Clin North Am,2010,48:999-1012.
[5]Berg WA.Image-guided breast biopsy and management of high-risk lesions[J].Radiol Clin North Am,2004,42:935-946.
[6]Burbank F.Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions:improved accuracy with directional,vacuum-assisted biopsy[J].Radiology,1997,202:843-847.
[7]Londero V,Zuiani C,Linda A,et al.Lobular neoplasia:core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features[J].Breast,2008,17:623-630.
[8]Lopez-Medina A,Cintora E,Mugica B,et al.Radial scars diagnosed at stereotactic core-needle biopsy:surgical biopsy findings[J].Eur Radiol,2006,16:1803-1810.
[9]Mesurolle B,Perez JC,Azzumea F,et al.Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy:frequency,final surgical outcome,and factors associated with underestimation[J].AJR,2014,202:1389-1394.
[10]Sen LQ,Berg WA,Hooley RJ,et al.Core breast biopsies showing lobular carcinoma in situ should be excised and surveillance is reasonable for atypical lobular hyperplasia[J].AJR,2016,207:1132-1145.
[11]Rageth CJ,O'Flynn EA,Comstock C,et al.First international consensus conference on lesions of uncertain malignant potential in the breast(B3 lesions)[J].Breast Cancer Res Treat,2016,159:203-213.
[12]Mooney KL,Bassett LW,Apple SK.Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy:a single-institution experience and literature review[J].Mod Pathol,2016,29:1471-1484.
[13]Morrow M,Schnitt SJ,Norton L.Current management of lesions associated with an increased risk of breast cancer[J].Nat Rev Clin Oncol,2015,12:227-238.
[14]Linda A,Zuiani C,Furlan A,et al.Nonsurgical management of high-risk lesions diagnosed at core needle biopsy:can malignancy be ruled out safely with breast MRI[J].AJR,2012,198:272-280.
[15]Krishnamurthy S,Bevers T,Kuerer HM,et al.Paradigm shifts in breast care delivery:impact of imaging in a multidisciplinary environment[J].AJR,2017,208:248-255.
[16]Bednarova I,Londero V,Linda A,et al.Do clinical and radiologic features help predict malignancy of B3 breast lesions without epithelial atypia(B3a)[J].Radiol Med,2018,123:809-817
[17]Kader T,Hill P,Rakha EA,et al.Atypical ductal hyperplasia:update on diagnosis,management,and molecular landscape[J].Breast Cancer Res,2018,20:39.
[18]Zeinomar N,Phillips KA,Daly MB,et al.Benign breast disease increases breast cancer risk independent of underlying familial risk profile:findings from a prospective family study cohort[J].Int J Cancer,2019.DOI:10.1002/ijc.32112.
[19]Degnim AC,Dupont WD,Radisky DC,et al.Extent of atypical hyperplasia stratifies breast cancer risk in 2 independent cohorts of women[J].Cancer,2016,122:2971-2978.
[20]Middleton LP,Sneige N,Coyne R,et al.Most lobular carcinoma in situ and atypical lobular hyperplasia diagnosed on core needle biopsy can be managed clinically with radiologic follow-up in a multidisciplinary setting[J].Cancer Med,2014,3:492-499.
[21]Wen X,Cheng W.Nonmalignant breast papillary lesions at coreneedle biopsy:a meta-analysis of underestimation and influencing factors[J].Ann Surg Oncol,2013,20:94-101.
[22]Cuneo KC,Dash RC,Wilke LG,et al.Risk of invasive breast cancer and ductal carcinoma in situ in women with atypical papillary lesions of the breast[J].Breast J,2012,18:475-478.
[23]Eiada R,Chong J,Kulkarni S,et al.Papillary lesions of the breast:MRI,ultrasound,and mammographic appearances[J].AJR,2012,198:264-271.
[24]Wang J,Yang X,Cai H,et al.Discrimination of breast cancer with microcalcifications on mammography by deep learning[J].Sci Rep,2016,6:27327.
[25]Cohen MA,Newell MS.Radial scars of the breast encountered at core biopsy:review of histologic,imaging,and management considerations[J].AJR,2017,209:1168-1177.
[26]柳杰,刘佩芳.数字乳腺断层摄影在乳腺筛查中的应用进展[J].国际医学放射学杂志,2018,41:319-323.
[27]Sharpe RJ,Venkataraman S,Phillips J,et al.Increased cancer detection rate and variations in the recall rate resulting from implementation of 3D digital breast tomosynthesis into a populationbased screening program[J].Radiology,2016,278:698-706.
[28]Skaane P,Bandos AI,Gullien R,et al.Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program[J].Radiology,2013,267:47-56.
[29]Lamb LR,Bahl M,Hughes KS,et al.Pathologic upgrade rates of high-risk breast lesions on digital two-dimensional vs tomosynthesis mammography[J].J Am Coll Surg,2018,226:858-867.
[30]Bahl M,Barzilay R,Yedidia AB,et al.High-risk breast lesions:a machine learning model to predict pathologic upgrade and reduce unnecessary surgical excision[J].Radiology,2018,286:810-818.
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