昨日美国快讯：穿刺活检诊断为乳腺导管不典型增生后的乳腺癌风险
编者按：以下数据来自欧洲大样本患者长期随访调查结果，无法完全代表中国患者实际情况和临床医生具体意见。以下原文为在线预先发表版，并非最终正式发表版。以下文字由谷歌翻译提供支持，欢迎留言提出修改建议，谢谢！
乳腺导管不典型增生（ADH）是乳腺癌的已知风险因素。既往发表的风险评估报告，均来自乳腺钼靶检查普及之前被诊断为ADH的女性队列，而且并未区分可能与ADH病灶大小相关的诊断方法，这些因素可能高估目前被诊断为ADH女性的风险。
2016年9月8日，《美国医学会杂志肿瘤学分册》在线发表特拉维夫索拉斯基医疗中心、特拉维夫大学赛克勒医学院、加利福尼亚大学旧金山分校、西雅图弗雷德·哈钦森癌症研究中心、纽约西奈山医疗中心、新墨西哥大学、加利福尼亚大学戴维斯分校的研究报告，探讨了使用穿刺活检对比切除活检用于诊断ADH的后续浸润性癌风险。
该队列研究比较了955331例女性进行乳腺钼靶检查后诊断、未诊断ADH的浸润性乳腺癌10年累积风险，数据来自参加美国国家癌症研究所资助乳腺癌监测联盟的5个乳腺影像登记处。通过空芯针穿刺活检或切除活检，对接受乳腺钼靶检查女性进行ADH的诊断。
结果发现：
共有1727例被诊断为ADH，其中通过空芯针穿刺活检、切除活检被诊断者分别为1058例（61.3%）和635例（36.8%）。
患者被诊断时的平均年龄为52.6（四分位：46.9～60.4）岁。
从1996年至2012年，通过空芯针穿刺活检诊断ADH的比例由21%提高至77%。
被诊断为ADH者，与未被诊断为ADH者相比，浸润性乳腺癌10年累积风险提高2.6（95%置信区间：2.0～3.4）倍。
对诊断方法（切除活检、空芯针穿刺活检）进行区分后，浸润性乳腺癌10年累积风险提高分别为3.0（95%置信区间：2～4.5）倍、2.2（95%置信区间：1.5～3.4）倍。
患者被诊断为ADH10年后，估计共有5.7%（95%置信区间：4.3%～10.1%）被诊断为浸润性癌。
切除活检与空芯针穿刺活检相比，诊断为ADH的风险略高，分别为6.7%（95%置信区间：3.0%～12.8%）、5%（95%置信区间：2.2%～8.9%）。
因此，目前的ADH诊断后浸润性乳腺癌10年风险可能低于既往报告。空芯针穿刺活检与切除活检相比，被诊断为ADH后发生浸润性乳腺癌的风险略低。
对此，维克弗斯特大学医学院外科肿瘤学家发表同期述评：如今ADH发展为乳腺癌的风险有多大？
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JAMA Oncol. 2016 Sep 8. [Epub ahead of print]
Subsequent Breast Cancer Risk Following Diagnosis of Atypical Ductal Hyperplasia on Needle Biopsy.
Tehillah S. Menes, Karla Kerlikowske, Jane Lange, Shabnam Jaffer, Robert Rosenberg, Diana L. Miglioretti.
Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University of California, San Francisco; Fred Hutchinson Cancer Research Center, Seattle, Washington; Mount Sinai Medical Center, New York, New York; Radiology Associates of Albuquerque, Albuquerque, New Mexico; University of New Mexico, Albuquerque, New Mexico; Group Health Research Institute, Group Health Cooperative, Seattle, Washington; University of California Davis School of Medicine, Sacramento.
IMPORTANCE: Atypical ductal hyperplasia (ADH) is a known risk factor for breast cancer. Published risk estimates are based on cohorts that included women whose ADH was diagnosed before widespread use of screening mammograms and did not differentiate between the methods used to diagnose ADH, which may be related to the size of the ADH focus. These risks may overestimate the risk in women with presently diagnosed ADH.
OBJECTIVE: To examine the risk of invasive cancer associated with ADH diagnosed using core needle biopsy vs excisional biopsy.
DESIGN: A cohort study was conducted comparing the 10-year cumulative risk of invasive breast cancer in 955,331 women undergoing mammography with and without a diagnosis of ADH. Data were obtained from 5 breast imaging registries that participate in the National Cancer Institute-funded Breast Cancer Surveillance Consortium.
EXPOSURES: Diagnosis of ADH on core needle biopsy or excisional biopsy in women undergoing mammography.
MAIN OUTCOMES AND MEASURES: Ten-year cumulative risk of invasive breast cancer.
RESULTS: The sample included 955,331 women with 1727 diagnoses of ADH, 1058 (61.3%) of which were diagnosed by core biopsy and 635 (36.8%) by excisional biopsy. The mean (interquartile range) age of the women at diagnosis was 52.6 (46.9-60.4) years. From 1996 to 2012, the proportion of ADH diagnosed by core needle biopsy increased from 21% to 77%. Ten years following a diagnosis of ADH, the cumulative risk of invasive breast cancer was 2.6 (95% CI, 2.0-3.4) times higher than the risk in women with no ADH. Atypical ductal hyperplasia diagnosed via excisional biopsy was associated with an adjusted hazard ratio (HR) of 3.0 (95% CI, 2-4.5) and, via core needle biopsy, with an adjusted HR of 2.2 (95% CI, 1.5-3.4). Ten years after an ADH diagnosis, an estimated 5.7% (95% CI, 4.3%-10.1%) of the women had a diagnosis of invasive cancer. Women with ADH diagnosed on excisional biopsy had a slightly higher risk (6.7%; 95% CI, 3.0%-12.8%) compared with those with ADH diagnosed via core needle biopsy (5%; 95% CI, 2.2%-8.9%).
CONCLUSIONS AND RELEVANCE: Current 10-year risks of invasive breast cancer after a diagnosis of ADH may be lower than those previously reported. The risk associated with ADH is slightly lower for women whose ADH was diagnosed by needle core biopsy compared with excisional biopsy.
DOI: 10.1001/jamaoncol.2016.3022
JAMA Oncol. 2016 Sep 8. [Epub ahead of print]
Atypical Ductal Hyperplasia: What Is the Current Risk for Developing Breast Cancer?
Marissa Howard-McNatt.
Wake Forest School of Medicine, Winston-Salem, North Carolina.
Since the 1985 report by Dupont and Page, women with atypical hyperplasia have been found to have an increased risk for developing breast cancer. Recent reports with long-term follow-up have shown the absolute risk for developing breast cancer to be within the range of 1% to 2% per year. Most of these studies were performed in cohorts starting in the 1960s, before the widespread use of screening mammograms and core biopsies. In the modern era, are we overestimating the risk of women with atypical hyperplasia for developing breast cancer?
DOI: 10.1001/jamaoncol.2016.3136