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乳腺不典型增生——风险评估和管理方案
Atypical Hyperplasia of the Breast — Risk Assessment and Management Options


Lynn C. Hartmann ... 肿瘤 • 2015.01.01

当乳腺超声检查或触诊发现有潜在恶性病变可能的肿块时,常通过乳腺活检来评估肿块性质,其结果大多为良性。美国每年有超过100万例的乳腺活检结果为良性1。根据肿块的组织学改变,我们有可能将这些活检结果为良性的女性归类到乳腺癌发生风险显著差异的不同组别2,3。不典型增生是一种高危的良性病变,存在于大约10%的良性活检结果中4。本文中,我们对这些良性病变进行研究,因为它们对于预测乳腺癌的发生具有重要意义。根据显微镜下形态,不典型增生可以分为两类:导管不典型增生和小叶不典型增生;两者发生率相当,发展为乳腺癌的风险也相似(表1)2,3,9,10。因此本文中,两者统称为“不典型增生”。





作者信息

Lynn C. Hartmann, M.D., Amy C. Degnim, M.D., Richard J. Santen, M.D., William D. Dupont, Ph.D., and Karthik Ghosh, M.D.

 

参考文献

1. Gutwein LG, Ang DN, Liu H, et al. Utilization of minimally invasive breast biopsy for the evaluation of suspicious breast lesions. Am J Surg 2011;202:127-132

2. Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med 1985;312:146-151

3. Hartmann LC, Sellers TA, Frost MH, et al. Benign breast disease and the risk of breast cancer. N Engl J Med 2005;353:229-237

4. Simpson JF. Update on atypical epithelial hyperplasia and ductal carcinoma in situ. Pathology 2009;41:36-39

5. Hartmann LC, Radisky DC, Frost MH, et al. Understanding the premalignant potential of atypical hyperplasia through its natural history: a longitudinal cohort study. Cancer Prev Res (Phila) 2014;7:211-217

6. Worsham MJ, Abrams J, Raju U, et al. Breast cancer incidence in a cohort of women with benign breast disease from a multiethnic, primary health care population. Breast J 2007;13:115-121

7. London SJ, Connolly JL, Schnitt SJ, Colditz GA. A prospective study of benign breast disease and the risk of breast cancer. JAMA 1992;267:941-944[Erratum, JAMA 1992;267:1780.]

8. Collins LC, Baer HJ, Tamimi RM, Connolly JL, Colditz GA, Schnitt SJ. The influence of family history on breast cancer risk in women with biopsy-confirmed benign breast disease: results from the Nurses' Health Study. Cancer 2006;107:1240-1247

9. Page DL, Dupont WD, Rogers LW, Rados MS. Atypical hyperplastic lesions of the female breast: a long-term follow-up study. Cancer 1985;55:2698-2708

10. Degnim AC, Visscher DW, Berman HK, et al. Stratification of breast cancer risk in women with atypia: a Mayo cohort study. J Clin Oncol 2007;25:2671-2677

11. Ellis IO. Intraductal proliferative lesions of the breast: morphology, associated risk and molecular biology. Mod Pathol 2010;23:Suppl 2:S1-S7

12. Allred DC, Mohsin SK, Fuqua SA. Histological and biological evolution of human premalignant breast disease. Endocr Relat Cancer 2001;8:47-61

13. Santen RJ, Mansel R. Benign breast disorders. N Engl J Med 2005;353:275-285

14. Bombonati A, Sgroi DC. The molecular pathology of breast cancer progression. J Pathol 2011;223:307-317

15. Page DL, Schuyler PA, Dupont WD, Jensen RA, Plummer WD Jr, Simpson JF. Atypical lobular hyperplasia as a unilateral predictor of breast cancer risk: a retrospective cohort study. Lancet 2003;361:125-129[Erratum, Lancet 2003;361:1994.]

16. Saslow D, Boetes C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 2007;57:75-89[Erratum, CA Cancer J Clin 2007;57:185.]

17. Waters EA, McNeel TS, Stevens WM, Freedman AN. Use of tamoxifen and raloxifene for breast cancer chemoprevention in 2010. Breast Cancer Res Treat 2012;134:875-880

18. Is `fibrocystic disease' of the breast precancerous? Arch Pathol Lab Med 1986;110:171-173

19. Fitzgibbons PL, Henson DE, Hutter RV. Benign breast changes and the risk for subsequent breast cancer: an update of the 1985 consensus statement. Arch Pathol Lab Med 1998;122:1053-1055

20. Lopez-Garcia MA, Geyer FC, Lacroix-Triki M, Marchio C, Reis-Filho JS. Breast cancer precursors revisited: molecular features and progression pathways. Histopathology 2010;57:171-192

21. Jain RK, Mehta R, Dimitrov R, et al. Atypical ductal hyperplasia: interobserver and intraobserver variability. Mod Pathol 2011;24:917-923

22. Schnitt SJ, Connolly JL, Tavassoli FA, et al. Interobserver reproducibility in the diagnosis of ductal proliferative breast lesions using standardized criteria. Am J Surg Pathol 1992;16:1133-1143

23. Ma XJ, Salunga R, Tuggle JT, et al. Gene expression profiles of human breast cancer progression. Proc Natl Acad Sci U S A 2003;100:5974-5979

24. Jacobs TW, Pliss N, Kouria G, Schnitt SJ. Carcinomas in situ of the breast with indeterminate features: role of E-cadherin staining in categorization. Am J Surg Pathol 2001;25:229-236

25. Barr FE, Degnim AC, Hartmann LC, et al. Estrogen receptor expression in atypical hyperplasia: lack of association with breast cancer. Cancer Prev Res (Phila) 2011;4:435-444

26. Baer HJ, Collins LC, Connolly JL, Colditz GA, Schnitt SJ, Tamimi RM. Lobule type and subsequent breast cancer risk: results from the Nurses' Health Studies. Cancer 2009;115:1404-1411

27. Milanese TR, Hartmann LC, Sellers TA, et al. Age-related lobular involution and risk of breast cancer. J Natl Cancer Inst 2006;98:1600-1607

28. National Comprehensive Cancer Network. Clinical practice guidelines: breast cancer screening and diagnosis, version 1. 2014 (http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#detection).

29. Deshaies I, Provencher L, Jacob S, et al. Factors associated with upgrading to malignancy at surgery of atypical ductal hyperplasia diagnosed on core biopsy. Breast 2011;20:50-55

30. Kohr JR, Eby PR, Allison KH, et al. Risk of upgrade of atypical ductal hyperplasia after stereotactic breast biopsy: effects of number of foci and complete removal of calcifications. Radiology 2010;255:723-730

31. McGhan LJ, Pockaj BA, Wasif N, Giurescu ME, McCullough AE, Gray RJ. Atypical ductal hyperplasia on core biopsy: an automatic trigger for excisional biopsy? Ann Surg Oncol 2012;19:3264-3269

32. Niell B, Specht M, Gerade B, Rafferty E. Is excisional biopsy required after a breast core biopsy yields lobular neoplasia? AJR Am J Roentgenol 2012;199:929-935

33. Shah-Khan MG, Geiger XJ, Reynolds C, Jakub JW, Deperi ER, Glazebrook KN. Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy. Ann Surg Oncol 2012;19:3131-3138

34. Murray MP, Luedtke C, Liberman L, Nehhozina T, Akram M, Brogi E. Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy: outcomes of prospective excision. Cancer 2013;119:1073-1079

35. Gail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 1989;81:1879-1886

36. Costantino JP, Gail MH, Pee D, et al. Validation studies for models projecting the risk of invasive and total breast cancer incidence. J Natl Cancer Inst 1999;91:1541-1548

37. Tyrer J, Duffy SW, Cuzick J. A breast cancer prediction model incorporating familial and personal risk factors. Stat Med 2004;23:1111-1130[Erratum, Stat Med 2005;24:156.]

38. Pankratz VS, Hartmann LC, Degnim AC, et al. Assessment of the accuracy of the Gail model in women with atypical hyperplasia. J Clin Oncol 2008;26:5374-5379

39. Boughey JC, Hartmann LC, Anderson SS, et al. Evaluation of the Tyrer-Cuzick (International Breast Cancer Intervention Study) model for breast cancer risk prediction in women with atypical hyperplasia. J Clin Oncol 2010;28:3591-3596

40. American Cancer Society. Recommendations for early breast cancer detection in women without breast symptoms. September 2014 (http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs).

41. Lee CH, Dershaw DD, Kopans D, et al. Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol 2010;7:18-27

42. Port ER, Park A, Borgen PI, Morris E, Montgomery LL. Results of MRI screening for breast cancer in high-risk patients with LCIS and atypical hyperplasia. Ann Surg Oncol 2007;14:1051-1057

43. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst 2005;97:1652-1662

44. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998;90:1371-1388

45. Powles T, Eeles R, Ashley S, et al. Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomised chemoprevention trial. Lancet 1998;352:98-101

46. Powles TJ, Ashley S, Tidy A, Smith IE, Dowsett M. Twenty-year follow-up of the Royal Marsden randomized, double-blinded tamoxifen breast cancer prevention trial. J Natl Cancer Inst 2007;99:283-290

47. Veronesi U, Maisonneuve P, Costa A, et al. Prevention of breast cancer with tamoxifen: preliminary findings from the Italian randomised trial among hysterectomised women: Italian Tamoxifen Prevention Study. Lancet 1998;352:93-97

48. Cuzick J, Sestak I, Bonanni B, et al. Selective oestrogen receptor modulators in prevention of breast cancer: an updated meta-analysis of individual participant data. Lancet 2013;381:1827-1834

49. Cuzick J, Forbes J, Edwards R, et al. First results from the International Breast Cancer Intervention Study (IBIS-I): a randomised prevention trial. Lancet 2002;360:817-824

50. Cuzick J, Forbes JF, Sestak I, et al. Long-term results of tamoxifen prophylaxis for breast cancer -- 96-month follow-up of the randomized IBIS-I trial. J Natl Cancer Inst 2007;99:272-282

51. Cuzick J, Warwick J, Pinney E, et al. Tamoxifen-induced reduction in mammographic density and breast cancer risk reduction: a nested case-control study. J Natl Cancer Inst 2011;103:744-752

52. Vogel VG, Costantino JP, Wickerham DL, et al. Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 2006;295:2727-2741[Erratum, JAMA 2006;296:2946, 2007;298:973.]

53. Vogel VG, Costantino JP, Wickerham DL, et al. Update of the National Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifene (STAR) P-2 Trial: preventing breast cancer. Cancer Prev Res (Phila) 2010;3:696-706

54. Goss PE, Ingle JN, Ales-Martinez JE, et al. Exemestane for breast-cancer prevention in postmenopausal women. N Engl J Med 2011;364:2381-2391[Erratum, N Engl J Med 2011;365:1361.]

55. Cauley JA, Norton L, Lippman ME, et al. Continued breast cancer risk reduction in postmenopausal women treated with raloxifene: 4-year results from the MORE trial. Breast Cancer Res Treat 2001;65:125-134[Erratum, Breast Cancer Res Treat 2001;67:191.]

56. Martino S, Cauley JA, Barrett-Connor E, et al. Continuing outcomes relevant to Evista: breast cancer incidence in postmenopausal osteoporotic women in a randomized trial of raloxifene. J Natl Cancer Inst 2004;96:1751-1761

57. Barrett-Connor E, Mosca L, Collins P, et al. Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Engl J Med 2006;355:125-137

58. LaCroix AZ, Powles T, Osborne CK, et al. Breast cancer incidence in the randomized PEARL trial of lasofoxifene in postmenopausal osteoporotic women. J Natl Cancer Inst 2010;102:1706-1715

59. Cummings SR, McClung M, Reginster JY, et al. Arzoxifene for prevention of fractures and invasive breast cancer in postmenopausal women. J Bone Miner Res 2011;26:397-404

60. Powles TJ, Diem SJ, Fabian CJ, et al. Breast cancer incidence in postmenopausal women with osteoporosis or low bone mass using arzoxifene. Breast Cancer Res Treat 2012;134:299-306

61. Cuzick J, Sestak I, Forbes JF, et al. Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial. Lancet 2014;383:1041-1048[Erratum, Lancet 2014;383:1040.]

62. Visvanathan K, Hurley P, Bantug E, et al. Use of pharmacologic interventions for breast cancer risk reduction: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2013;31:2942-2962[Erratum, J Clin Oncol 2013;31:4383.]

63. Freedman AN, Yu B, Gail MH, et al. Benefit/risk assessment for breast cancer chemoprevention with raloxifene or tamoxifen for women age 50 years or older. J Clin Oncol 2011;29:2327-2333[Erratum, J Clin Oncol 2013;31:4167.]

64. Gail MH, Costantino JP, Bryant J, et al. Weighing the risks and benefits of tamoxifen treatment for preventing breast cancer. J Natl Cancer Inst 1999;91:1829-1846[Erratum, J Natl Cancer Inst 2000;92:275.]

65. Taylor R, Taguchi K. Tamoxifen for breast cancer chemoprevention: low uptake by high-risk women after evaluation of a breast lump. Ann Fam Med 2005;3:242-247

66. Kaplan CP, Haas JS, Perez-Stable EJ, Des Jarlais G, Gregorich SE. Factors affecting breast cancer risk reduction practices among California physicians. Prev Med 2005;41:7-15

67. Port ER, Montgomery LL, Heerdt AS, Borgen PI. Patient reluctance toward tamoxifen use for breast cancer primary prevention. Ann Surg Oncol 2001;8:580-585

68. Ozanne EM, Wittenberg E, Garber JE, Weeks JC. Breast cancer prevention: patient decision making and risk communication in the high risk setting. Breast J 2010;16:38-47

69. National Comprehensive Cancer Network. Clinical practice guidelines in oncology: breast cancer, version 3. 2014 (http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site).

70. Allred DC, Anderson SJ, Paik S, et al. Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. J Clin Oncol 2012;30:1268-1273

71. National Comprehensive Cancer Network. Clinical practice guidelines in oncology: breast cancer: risk reduction, version 1. 2014 (http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#detection).

72. U.S. Preventive Services Task Force. Recommendation statement — breast cancer: medications for risk reduction. September 2013 (http://www.uspreventiveservicestaskforce.org/uspstf13/breastcanmeds/breastcanmedsrs.htm).

73. Giuliano AE, Boolbol S, Degnim A, Kuerer H, Leitch AM, Morrow M. Society of Surgical Oncology: position statement on prophylactic mastectomy -- approved by the Society of Surgical Oncology Executive Council, March 2007. Ann Surg Oncol 2007;14:2425-2427

74. Rueth NM, McMahon M, Arrington AK, Swenson K, Leach J, Tuttle TM. Preoperative risk assessment among women undergoing bilateral prophylactic mastectomy for cancer risk reduction. Ann Surg Oncol 2011;18:2515-2520

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