|
惡性可能未定的乳腺病變（B3）第二屆國(guó)際共識(shí)會(huì)議于2018年3月在瑞士蘇黎世舉行，由國(guó)際乳腺超聲學(xué)院組織，對(duì)于共識(shí)推薦意見進(jìn)行了重新評(píng)估。 2018年11月30日，施普林格·自然旗下《乳腺癌研究與治療》在線發(fā)表瑞士日內(nèi)瓦大學(xué)醫(yī)院、巴登州立醫(yī)院、蘇黎世乳腺中心、伯爾尼大學(xué)醫(yī)院、巴塞爾大學(xué)、圣加侖州立醫(yī)院、恩格利德醫(yī)院、蘇黎世大學(xué)醫(yī)院、烏伊蒂孔瓦爾德格醫(yī)院、英國(guó)倫敦大學(xué)圣喬治醫(yī)院、美國(guó)紐約紀(jì)念醫(yī)院斯隆凱特林癌癥中心、德國(guó)奧斯納布呂克馬里安醫(yī)院、迪特里希朋霍費(fèi)爾醫(yī)院、慕尼黑大學(xué)、奧地利維也納醫(yī)科大學(xué)、意大利博洛尼亞大學(xué)、法國(guó)巴黎文理研究大學(xué)居里研究所的研究報(bào)告，評(píng)估了2016年第一次蘇黎世共識(shí)會(huì)議對(duì)B3病變管理推薦建議對(duì)日常實(shí)踐的影響，回顧了目前關(guān)于活檢推薦意見的文獻(xiàn)。 結(jié)果，2018年B3病變管理共識(shí)推薦意見基本不變：
該研究對(duì)記錄3萬多例手術(shù)的瑞士微創(chuàng)乳腺活檢（MIBB）數(shù)據(jù)庫進(jìn)行分析，對(duì)于真空輔助活檢診斷病變，推薦密切監(jiān)測(cè)的比例日趨提高：
因此，該研究結(jié)果表明，對(duì)于大多數(shù)B3病變（導(dǎo)管異型增生和葉狀腫瘤除外），結(jié)合真空輔助活檢的微創(chuàng)處理仍然適合作為一線開放手術(shù)切除的替代方案，但是需要密切監(jiān)測(cè)，尤其對(duì)于小葉腫瘤。 Breast Cancer Res Treat. 2018 Nov 30. Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Christoph J. Rageth, Elizabeth A. M. O'Flynn, Katja Pinker, Rahel A. Kubik-Huch, Alexander Mundinger, Thomas Decker, Christoph Tausch, Florian Dammann, Pascal A. Baltzer, Eva Maria Fallenberg, Maria P. Foschini, Sophie Dellas, Michael Knauer, Caroline Malhaire, Martin Sonnenschein, Andreas Boos, Elisabeth Morris, Zsuzsanna Varga. Hopitaux Universitaires de Genève, Geneva, Switzerland; St George's University Hospitals NHS Foundation Trust, London, UK; Memorial Sloan Kettering Cancer Center, New York, USA; Kantonsspital Baden, Baden, Switzerland; Zentrum Radiologie der Niels-Stensen-Kliniken; Marienhospital Osnabrück, Osnabrück, Germany; Institut für Pathologie am Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany; Brust-Zentrum Zürich, Zurich, Switzerland; University Hospital Bern, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; Ludwig Maximilian University Munich, Munich, Germany; University of Bologna, Bologna, Italy; University of Basel, Basel, Switzerland; Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Institut Curie, PSL Research University, Paris, France; Klinik Engeried, Lindenhofgruppe AG, Bern, Switzerland; University Hospital Zurich, Zurich, Switzerland; Uitikon Waldegg, Switzerland. PURPOSE: The second International Consensus Conference on B3 lesions was held in Zurich, Switzerland, in March 2018, organized by the International Breast Ultrasound School to re-evaluate the consensus recommendations. METHODS: This study (1) evaluated how management recommendations of the first Zurich Consensus Conference of 2016 on B3 lesions had influenced daily practice and (2) reviewed current literature towards recommendations to biopsy. RESULTS: In 2018, the consensus recommendations for management of B3 lesions remained almost unchanged: For flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL) and radial scars (RS) diagnosed on core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB), excision by VAB in preference to open surgery, and for atypical ductal hyperplasia (ADH) and phyllodes tumors (PT) diagnosed at VAB or CNB, first-line open surgical excision (OE) with follow-up surveillance imaging for 5 years. Analyzing the Database of the Swiss Minimally Invasive Breast Biopsies (MIBB) with more than 30,000 procedures recorded, there was a significant increase in recommending more frequent surveillance of LN [65% in 2018 vs. 51% in 2016 (p=0.004)], FEA (72% in 2018 vs. 62% in 2016 (p=0.005)), and PL [(76% in 2018 vs. 70% in 2016 (p=0.04)] diagnosed on VAB. A trend to more frequent surveillance was also noted also for RS [77% in 2018 vs. 67% in 2016 (p=0.07)]. CONCLUSIONS: Minimally invasive management of B3 lesions (except ADH and PT) with VAB continues to be appropriate as an alternative to first-line OE in most cases, but with more frequent surveillance, especially for LN. KEYWORDS: B3 lesions Vacuum-assisted biopsy Consensus Breast Uncertain malignant potential Breast surgery DOI: 10.1007/s10549-018-05071-1
|
|
|
