First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)
Tóm tắt
The purpose of this study is to obtain a consensus for the therapy of B3 lesions. The first International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) including atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL), benign phyllodes tumors (PT), and radial scars (RS) took place in January 2016 in Zurich, Switzerland organized by the International Breast Ultrasound School and the Swiss Minimally Invasive Breast Biopsy group—a subgroup of the Swiss Society of Senology. Consensus recommendations for the management and follow-up surveillance of these B3 lesions were developed and areas of research priorities were identified. The consensus recommendation for FEA, LN, PL, and RS diagnosed on core needle biopsy or vacuum-assisted biopsy (VAB) is to therapeutically excise the lesion seen on imaging by VAB and no longer by open surgery, with follow-up surveillance imaging for 5 years. The consensus recommendation for ADH and PT is, with some exceptions, therapeutic first-line open surgical excision. Minimally invasive management of selected B3 lesions with therapeutic VAB is acceptable as an alternative to first-line surgical excision.
Tài liệu tham khảo
Perry N, Broeders M, de Wolf C, Tornberg S, Holland R, von Karsa L (2008) European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition–summary document. Ann Oncol 19:614–622
Lakhani SREI, Schnitt SJ, Tan PH, van de Vijver MJ (2012) WHO classification of tumours of the breast, fourth edition 2012. International Agency for Research on Cancer, Lyon
Pathology N-oDSotNCGfBS. Guidelines for non-operative diagnostic procedures and reporting in breast cancer screening. NHSBSP Publication No 50. (2001)
El-Sayed ME, Rakha EA, Reed J, Lee AH, Evans AJ, Ellis IO (2008) Audit of performance of needle core biopsy diagnoses of screen detected breast lesions. Eur J Cancer 44:2580–2586
Rakha EA, Ho BC, Naik V, Sen S, Hamilton LJ, Hodi Z et al (2011) Outcome of breast lesions diagnosed as lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4) on needle core biopsy, including detailed review of epithelial atypia. Histopathology 58:626–632
O’Flynn EA, Wilson AR, Michell MJ (2010) Image-guided breast biopsy: state-of-the-art. Clin Radiol 65:259–270
Alonso-Bartolome P, Vega-Bolivar A, Torres-Tabanera M, Ortega E, Acebal-Blanco M, Garijo-Ayensa F et al (2004) Sonographically guided 11-G directional vacuum-assisted breast biopsy as an alternative to surgical excision: utility and cost study in probably benign lesions. Acta Radiol 45:390–396
Saladin C, Haueisen H, Kampmann G, Oehlschlegel C, Seifert B, Rageth L et al (2015) Lesions with unclear malignant potential (B3) after minimally invasive breast biopsy: evaluation of vacuum biopsies performed in Switzerland and recommended further management. Acta Radiol. 0284185115610931
Neuschatz AC, DiPetrillo T, Safaii H, Price LL, Schmidt-Ullrich RK, Wazer DE (2003) Long-term follow-up of a prospective policy of margin-directed radiation dose escalation in breast-conserving therapy. Cancer 97:30–39
Page DL, Dupont WD, Rogers LW, Rados MS (1985) Atypical hyperplastic lesions of the female breast. A long-term follow-up study. Cancer. 55:2698–2708
Tavassoli FA, Norris HJ (1990) A comparison of the results of long-term follow-up for atypical intraductal hyperplasia and intraductal hyperplasia of the breast. Cancer 65:518–529
(AGO) AGO. Guidelines of the AGO breast committee: lesions of uncertain malignant potential (B3) (ADH, LIN, FEA, Papilloma, Radial Scar). http://www.ago-onlinede/fileadmin/downloads/leitlinien/mamma/Maerz2016/en/2016E%2006_Lesions%20of%20Uncertain%20Malignant%20Potential%20%28B3%29pdf. 2016
Brem RF, Behrndt VS, Sanow L, Gatewood OM (1999) Atypical ductal hyperplasia: histologic underestimation of carcinoma in tissue harvested from impalpable breast lesions using 11-gauge stereotactically guided directional vacuum-assisted biopsy. AJR Am J Roentgenol 172:1405–1407
Deshaies I, Provencher L, Jacob S, Cote G, Robert J, Desbiens C et al (2011) Factors associated with upgrading to malignancy at surgery of atypical ductal hyperplasia diagnosed on core biopsy. Breast 20:50–55
Houssami N, Ciatto S, Ellis I, Ambrogetti D (2007) Underestimation of malignancy of breast core-needle biopsy: concepts and precise overall and category-specific estimates. Cancer 109:487–495
Jackman RJ, Nowels KW, Rodriguez-Soto J, Marzoni FA Jr, Finkelstein SI, Shepard MJ (1999) Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up. Radiology 210:799–805
Kettritz U, Rotter K, Schreer I, Murauer M, Schulz-Wendtland R, Peter D et al (2004) Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study. Cancer 100:245–251
Teng-Swan Ho J, Tan PH, Hee SW, Su-Lin Wong J (2008) Underestimation of malignancy of atypical ductal hyperplasia diagnosed on 11-gauge stereotactically guided mammotome breast biopsy: an Asian breast screen experience. Breast 17:401–406
Ancona A, Capodieci M, Galiano A, Mangieri F, Lorusso V, Gatta G (2011) Vacuum-assisted biopsy diagnosis of atypical ductal hyperplasia and patient management. Radiol Med 116:276–291
Bedei L, Falcini F, Sanna PA, Casadei Giunchi D, Innocenti MP, Vignutelli P et al (2006) Atypical ductal hyperplasia of the breast: the controversial management of a borderline lesion: experience of 47 cases diagnosed at vacuum-assisted biopsy. Breast 15:196–202
Gumus H, Mills P, Gumus M, Fish D, Jones S, Jones P et al (2013) Factors that impact the upgrading of atypical ductal hyperplasia. Diagn Interv Radiol 19:91–96
Londero V, Zuiani C, Linda A, Battigelli L, Brondani G, Bazzocchi M (2011) Borderline breast lesions: comparison of malignancy underestimation rates with 14-gauge core needle biopsy versus 11-gauge vacuum-assisted device. Eur Radiol 21:1200–1206
Pandelidis S, Heiland D, Jones D, Stough K, Trapeni J, Suliman Y (2003) Accuracy of 11-gauge vacuum-assisted core biopsy of mammographic breast lesions. Ann Surg Oncol 10:43–47
Polom K, Murawa D, Kurzawa P, Michalak M, Murawa P (2012) Underestimation of cancer in case of diagnosis of atypical ductal hyperplasia (ADH) by vacuum assisted core needle biopsy. Rep Pract Oncol Radiother 17:129–133
Sohn V, Keylock J, Arthurs Z, Wilson A, Herbert G, Perry J et al (2007) Breast papillomas in the era of percutaneous needle biopsy. Ann Surg Oncol 14:2979–2984
Forgeard C, Benchaib M, Guerin N, Thiesse P, Mignotte H, Faure C et al (2008) Is surgical biopsy mandatory in case of atypical ductal hyperplasia on 11-gauge core needle biopsy? A retrospective study of 300 patients. Am J Surg 196:339–345
Kohr JR, Eby PR, Allison KH, DeMartini WB, Gutierrez RL, Peacock S et al (2010) Risk of upgrade of atypical ductal hyperplasia after stereotactic breast biopsy: effects of number of foci and complete removal of calcifications. Radiology 255:723–730
McGhan LJ, Pockaj BA, Wasif N, Giurescu ME, McCullough AE, Gray RJ (2012) A typical ductal hyperplasia on core biopsy: an automatic trigger for excisional biopsy? Ann Surg Oncol 19:3264–3269
Villa A, Tagliafico A, Chiesa F, Chiaramondia M, Friedman D, Calabrese M (2011) Atypical ductal hyperplasia diagnosed at 11-gauge vacuum-assisted breast biopsy performed on suspicious clustered microcalcifications: could patients without residual microcalcifications be managed conservatively? AJR Am J Roentgenol 197:1012–1018
Hsu HH, Yu JC, Hsu GC, Yu CP, Chang WC, Tung HJ et al (2012) Atypical ductal hyperplasia of the breast diagnosed by ultrasonographically guided core needle biopsy. Ultraschall Med 33:447–454
Youk JH, Kim EK, Kim MJ (2009) Atypical ductal hyperplasia diagnosed at sonographically guided 14-gauge core needle biopsy of breast mass. AJR Am J Roentgenol 192:1135–1141
Chae BJ, Lee A, Song BJ, Jung SS (2009) Predictive factors for breast cancer in patients diagnosed atypical ductal hyperplasia at core needle biopsy. World J Surg Oncol 7:77
Grady I, Gorsuch H, Wilburn-Bailey S (2005) Ultrasound-guided, vacuum-assisted, percutaneous excision of breast lesions: an accurate technique in the diagnosis of atypical ductal hyperplasia. J Am Coll Surg 201:14–17
Jang M, Cho N, Moon WK, Park JS, Seong MH, Park IA (2008) Underestimation of atypical ductal hyperplasia at sonographically guided core biopsy of the breast. AJR Am J Roentgenol 191:1347–1351
Lourenco AP, Khalil H, Sanford M, Donegan L (2014) High-risk lesions at MRI-guided breast biopsy: frequency and rate of underestimation. AJR Am J Roentgenol 203:682–686
Hartmann LC, Radisky DC, Frost MH, Santen RJ, Vierkant RA, Benetti LL et al (2014) Understanding the premalignant potential of atypical hyperplasia through its natural history: a longitudinal cohort study. Cancer Prev Res (Phila) 7:211–217
Liberman L, Holland AE, Marjan D, Murray MP, Bartella L, Morris EA et al (2007) Underestimation of atypical ductal hyperplasia at MRI-guided 9-gauge vacuum-assisted breast biopsy. AJR Am J Roentgenol 188:684–690
Ely KA, Carter BA, Jensen RA, Simpson JF, Page DL (2001) Core biopsy of the breast with atypical ductal hyperplasia: a probabilistic approach to reporting. Am J Surg Pathol 25:1017–1021
Sanders ME, Schuyler PA, Dupont WD, Page DL (2005) The natural history of low-grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long-term follow-up. Cancer 103:2481–2484
Sneige N, Lim SC, Whitman GJ, Krishnamurthy S, Sahin AA, Smith TL et al (2003) Atypical ductal hyperplasia diagnosis by directional vacuum-assisted stereotactic biopsy of breast microcalcifications. Considerations for surgical excision. Am J Clin Pathol 119:248–253
Dabbs DJ (2012) Breast pathology
Tavassoli FA DP (2003) (ed). Pathology and genetics of tumours of the breast and female genital organs
Chivukula M, Bhargava R, Tseng G, Dabbs DJ (2009) Clinicopathologic implications of “flat epithelial atypia” in core needle biopsy specimens of the breast. Am J Clin Pathol 131:802–808
Darvishian F, Singh B, Simsir A, Ye W, Cangiarella JF (2009) Atypia on breast core needle biopsies: reproducibility and significance. Ann Clin Lab Sci 39:270–276
Ingegnoli A, d’Aloia C, Frattaruolo A, Pallavera L, Martella E, Crisi G et al (2010) Flat epithelial atypia and atypical ductal hyperplasia: carcinoma underestimation rate. Breast J 16:55–59
Kunju LP, Kleer CG (2007) Significance of flat epithelial atypia on mammotome core needle biopsy: should it be excised? Hum Pathol 38:35–41
Piubello Q, Parisi A, Eccher A, Barbazeni G, Franchini Z, Iannucci A (2009) Flat epithelial atypia on core needle biopsy: which is the right management? Am J Surg Pathol 33:1078–1084
Senetta R, Campanino PP, Mariscotti G, Garberoglio S, Daniele L, Pennecchi F et al (2009) Columnar cell lesions associated with breast calcifications on vacuum-assisted core biopsies: clinical, radiographic, and histological correlations. Mod Pathol 22:762–769
Bodian CA, Perzin KH, Lattes R (1996) Lobular neoplasia. long term risk of breast cancer and relation to other factors. Cancer 78:1024–1034
D’Alfonso TM, Wang K, Chiu YL, Shin SJ (2013) Pathologic upgrade rates on subsequent excision when lobular carcinoma in situ is the primary diagnosis in the needle core biopsy with special attention to the radiographic target. Arch Pathol Lab Med 137:927–935
Haagensen DE Jr, Mazoujian G, Dilley WG, Pedersen CE, Kister SJ, Wells SA Jr (1979) Breast gross cystic disease fluid analysis. I. isolation and radioimmunoassay for a major component protein. J Natl Cancer Inst 62:239–247
Ottesen GL, Graversen HP, Blichert-Toft M, Christensen IJ, Andersen JA (2000) Carcinoma in situ of the female breast. 10 year follow-up results of a prospective nationwide study. Breast Cancer Res Treat 62:197–210
Page DL, Kidd TE Jr, Dupont WD, Simpson JF, Rogers LW (1991) Lobular neoplasia of the breast: higher risk for subsequent invasive cancer predicted by more extensive disease. Hum Pathol 22:1232–1239
Liberman L, Bracero N, Vuolo MA, Dershaw DD, Morris EA, Abramson AF et al (1999) Percutaneous large-core biopsy of papillary breast lesions. AJR Am J Roentgenol 172:331–337
Mercado CL, Hamele-Bena D, Singer C, Koenigsberg T, Pile-Spellman E, Higgins H et al (2001) Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy. Radiology 221:650–655
Philpotts LE, Shaheen NA, Jain KS, Carter D, Lee CH (2000) Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology 216:831–837
Reynolds HE (2000) Core needle biopsy of challenging benign breast conditions: a comprehensive literature review. AJR Am J Roentgenol 174:1245–1250
Chang JM, Moon WK, Cho N, Han W, Noh DY, Park IA et al (2011) Management of ultrasonographically detected benign papillomas of the breast at core needle biopsy. AJR Am J Roentgenol 196:723–729
Bianchi S, Bendinelli B, Saladino V, Vezzosi V, Brancato B, Nori J et al (2015) Non-malignant breast papillary lesions - b3 diagnosed on ultrasound–guided 14-gauge needle core biopsy: analysis of 114 cases from a single institution and review of the literature. Pathol Oncol Res 21:535–546
Kim MJ, Kim SI, Youk JH, Moon HJ, Kwak JY, Park BW et al (2011) The diagnosis of non-malignant papillary lesions of the breast: comparison of ultrasound-guided automated gun biopsy and vacuum-assisted removal. Clin Radiol 66:530–535
Chang JM, Han W, Moon WK, Cho N, Noh DY, Park IA et al (2011) Papillary lesions initially diagnosed at ultrasound-guided vacuum-assisted breast biopsy: rate of malignancy based on subsequent surgical excision. Ann Surg Oncol 18:2506–2514
Mosier AD, Keylock J, Smith DV (2013) Benign papillomas diagnosed on large-gauge vacuum-assisted core needle biopsy which span < 1.5 cm do not need surgical excision. Breast J. 19:611–617
Youk JH, Kim MJ, Son EJ, Kwak JY, Kim EK (2012) US-guided vacuum-assisted percutaneous excision for management of benign papilloma without atypia diagnosed at US-guided 14-gauge core needle biopsy. Ann Surg Oncol 19:922–928
Wyss P, Varga Z, Rossle M, Rageth CJ (2014) Papillary lesions of the breast: outcomes of 156 patients managed without excisional biopsy. Breast J 20:394–401
Yamaguchi R, Tanaka M, Tse GM, Yamaguchi M, Terasaki H, Hirai Y et al (2015) Management of breast papillary lesions diagnosed in ultrasound-guided vacuum-assisted and core needle biopsies. Histopathology 66:565–576
Buchanan EB (1995) Cystosarcoma phyllodes and its surgical management. Am surg 61:350–355
Yang X, Kandil D, Cosar EF, Khan A (2014) Fibroepithelial tumors of the breast: pathologic and immunohistochemical features and molecular mechanisms. Arch Pathol Lab Med 138:25–36
Krishnamurthy S, Ashfaq R, Shin HJ, Sneige N (2000) Distinction of phyllodes tumor from fibroadenoma: a reappraisal of an old problem. Cancer 90:342–349
Tse GM, Niu Y, Shi HJ (2010) HJ Phyllodes tumor of the breast: an update. Breast cancer 17:29–34
Bode MK, Rissanen T, Apaja-Sarkkinen M (2007) Ultrasonography and core needle biopsy in the differential diagnosis of fibroadenoma and tumor phyllodes. Acta Radiol 48:708–713
Youn I, Choi SH, Moon HJ, Kim MJ, Kim EK (2013) Phyllodes tumors of the breast: ultrasonographic findings and diagnostic performance of ultrasound-guided core needle biopsy. Ultrasound Med Biol 39:987–992
Choi J, Koo JS (2012) Comparative study of histological features between core needle biopsy and surgical excision in phyllodes tumor. Pathol Int 62:120–126
Youk JH, Kim H, Kim EK, Son EJ, Kim MJ, Kim JA (2015) Phyllodes tumor diagnosed after ultrasound-guided vacuum-assisted excision: should it be followed by surgical excision? Ultrasound Med Biol 41:741–747
Ouyang Q, Li S, Tan C, Zeng Y, Zhu L, Song E et al (2016) Benign phyllodes tumor of the breast diagnosed after ultrasound-guided vacuum-assisted biopsy: surgical excision or wait-and-watch? Ann Surg Oncol 23:1129–1134
Park HL, Kwon SH, Chang SY, Huh JY, Kim JY, Shim JY et al (2012) Long-term follow-up result of benign phyllodes tumor of the breast diagnosed and excised by ultrasound-guided vacuum-assisted breast biopsy. J breast cancer 15:224–229
Zurrida S, Bartoli C, Galimberti V, Squicciarini P, Delledonne V, Veronesi P et al (1992) Which therapy for unexpected phyllode tumour of the breast? Eur J Cancer 28:654–657
Kim S, Kim JY (2013) Kim do H, Jung WH, Koo JS. Analysis of phyllodes tumor recurrence according to the histologic grade. Breast Cancer Res Treat 141:353–363
McCarthy E, Kavanagh J, O’Donoghue Y, McCormack E, D’Arcy C, O’Keeffe SA (2014) Phyllodes tumours of the breast: radiological presentation, management and follow-up. Br J Radiol 87:20140239
Barrio AV, Clark BD, Goldberg JI, Hoque LW, Bernik SF, Flynn LW et al (2007) Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol 14:2961–2970
Chaney AW, Pollack A, McNeese MD, Zagars GK, Pisters PW, Pollock RE et al (2000) Primary treatment of cystosarcoma phyllodes of the breast. Cancer 89:1502–1511
Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ, Cyr A et al (2016) Invasive Breast Cancer Version 1.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw 14:324–354
Douglas-Jones AG, Denson JL, Cox AC, Harries IB, Stevens G (2007) Radial scar lesions of the breast diagnosed by needle core biopsy: analysis of cases containing occult malignancy. J Clin Pathol 60:295–298
Farshid G, Rush G (2004) Assessment of 142 stellate lesions with imaging features suggestive of radial scar discovered during population-based screening for breast cancer. Am J Surg Pathol 28:1626–1631
Fasih T, Jain M, Shrimankar J, Staunton M, Hubbard J, Griffith CD (2005) All radial scars/complex sclerosing lesions seen on breast screening mammograms should be excised. Eur J Surg Oncol 31:1125–1128
Linda A, Zuiani C, Furlan A, Londero V, Girometti R, Machin P et al (2010) Radial scars without atypia diagnosed at imaging-guided needle biopsy: how often is associated malignancy found at subsequent surgical excision, and do mammography and sonography predict which lesions are malignant? Am J Roentgenol 194:1146–1151
Orel SG, Evers K, Yeh IT, Troupin RH (1992) Radial scar with microcalcifications: radiologic-pathologic correlation. Radiology 183:479–482
Sloane JP, Mayers MM (1993) Carcinoma and atypical hyperplasia in radial scars and complex sclerosing lesions: importance of lesion size and patient age. Histopathology 23:225–231
Berg JC, Visscher DW, Vierkant RA, Pankratz VS, Maloney SD, Lewis JT et al (2008) Breast cancer risk in women with radial scars in benign breast biopsies. Breast Cancer Res Treat 108:167–174
Jacobs TW, Byrne C, Colditz G, Connolly JL, Schnitt SJ (1999) Radial scars in benign breast-biopsy specimens and the risk of breast cancer. N Engl J Med 340:430–436
Sanders ME, Page DL, Simpson JF, Schuyler PA, Dale Plummer W, Dupont WD (2006) Interdependence of radial scar and proliferative disease with respect to invasive breast carcinoma risk in patients with benign breast biopsies. Cancer 106:1453–1461
Sagara Y, Mallory MA, Wong S, Aydogan F, DeSantis S, Barry WT et al (2015) Survival benefit of breast surgery for low-grade ductal carcinoma in situ: a population-based cohort study. JAMA Surg 150:739–745
Ryser MD, Worni M, Turner EL, Marks JR, Durrett R (2016) Hwang ES. A Computational Risk Analysis. J Natl Cancer Inst, Outcomes of Active Surveillance for Ductal Carcinoma in Situ, p 108
Francis A, Fallowfield L, Rea D (2015) The LORIS Trial: addressing overtreatment of ductal carcinoma in situ. Clin oncol (Royal College of Radiologists (Great Britain)) 27:6–8
Kuerer HM (2015) Ductal carcinoma in situ: treatment or active surveillance? Expert Rev Anticancer Ther 15:777–785