Long-Term Follow-Up of High-Risk Breast Lesions at Vacuum-Assisted Biopsy without Subsequent Surgical Resection.

Autor:	Elfgen C; Breast-Center Zurich, Zurich, Switzerland.; Department of Medicine, University of Witten-Herdecke, Witten, Germany., Varga Z; Department of Pathology and Molecular Pathology, University Hospital Zürich, Zurich, Switzerland., Breitling K; Breast Center, Kantonsspital Schaffhausen, Schaffhausen, Switzerland., Pauli E; Breast Center, Kantonsspital Frauenfeld, Frauenfeld, Switzerland., Schwegler-Guggemos D; Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland., Kampmann G; Centro di Radiologia e Senologia Luganese, Lugano, Switzerland., Kubik-Huch RA; Department of Radiology, Kantonsspital Baden, Baden, Switzerland., Leo C; Breast Center, Kantonsspital Baden, Baden, Switzerland., Lepori D; Imagerie du flon, Lausanne, Switzerland., Sonnenschein M; Radiology Section, Breast Center Lindenhofgruppe AG, Bern, Switzerland., Tausch C; Breast-Center Zurich, Zurich, Switzerland.; Department of Medicine, University of Basel, Basel, Switzerland., Schrading S; Department of Radiology and Nuclear Medicine, Kantonsspital Lucerne, Lucerne, Switzerland.
Jazyk:	angličtina
Zdroj:	Breast care (Basel, Switzerland) [Breast Care (Basel)] 2024 Feb; Vol. 19 (1), pp. 62-72. Date of Electronic Publication: 2023 Sep 07.
DOI:	10.1159/000533673
Abstrakt:	Introduction: B3-lesions of the breast are a heterogeneous group of neoplasms, associated with a higher risk of breast cancer. Recent studies show a low upgrade rate into malignancy after subsequent open surgical excision (OE) of most B3-lesions when proven by vacuum-assisted biopsy (VAB). However, there is a lack of long-term follow-up data after VAB of high-risk lesions. The primary aim of this study was to demonstrate whether follow-up of B3 lesions is a beneficial and reliable alternative to OE in terms of long-term outcome. The secondary aim was to identify patient and lesion characteristics of B3 lesions for which OE is still necessary. Methods: This retrospective multicenter study was conducted at 8 Swiss breast centers between 2010 and 2019. A total of 278 women (mean age: 53.5 ± 10.7 years) with 286 B3-lesions who had observation only and who had at least 24 months of follow-up were included. Any event during follow-up (ductal carcinoma in situ [DCIS], invasive cancer, new B3-lesion) was systematically recorded. Data from women who had an event during follow-up were compared with those who did not. The results for the different B3 lesions were analyzed using the t test and Fisher's exact test. A p value of <0.05 was considered statistically significant. Results: The median follow-up interval was 59 months (range: 24-143 months) with 52% (148/286) having a follow-up of more than 5 years. During follow-up, in 42 women, 44 suspicious lesions occurred, with 36.4% (16/44) being invasive cancer and 6.8% (3/44) being DCIS. Thus, 6.6% (19/286) of all women developed malignancy during follow-up after a median follow-up interval of 6.5 years (range: 31-119 months). The initial histology of the B3 lesion influenced the subsequent occurrence of a malignant lesion during follow-up ( p < 0.038). The highest malignancy-developing rate was observed in atypical ductal hyperplasia (ADH) (24%, 19/79), while all other B3-lesions had malignant findings ipsi- and contralateral between 0% and 6%. The results were not influenced by the VAB method (Mx-, US-, magnetic resonance imaging-guided), the radiological characteristics of the lesion, or the age or menopausal status of the patient ( p > 0.12). Conclusion: With a low risk of <6% of developing malignancy, VAB followed by long-term follow-up is a safe alternative to OE for most B3-lesions. A higher malignancy rate only occurred in ADH (24%). Based on our results, radiological follow-up should be bilateral, preferable using the technique of initial diagnosis. As we observed a late peak (6-7 years) of breast malignancies after B3-lesions, follow-up should be continued for a longer period (>10 years). Knowledge of these long-term outcome results will be helpful in making treatment decisions and determining the optimal radiological follow-up interval. Competing Interests: All authors declare that they have no conflict of interest. (© 2023 The Author(s). Published by S. Karger AG, Basel.)
Databáze:	MEDLINE
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