滤泡性增生病变的最新研究进展。
Update on Lobular Neoplasia.
发表日期:2023 Oct
作者:
Samantha L Heller, Yiming Gao
来源:
RADIOGRAPHICS
摘要:
小叶肿瘤(LN)是包括小叶原位癌(LCIS)和非典型小叶增生(ALH)在内的一种组织病理学实体。LN的管理被认为是多样化的,依赖于机构。在经皮乳腺活检诊断中发现LN后的治疗方法的可变性部分源于文献中的异质性,导致初始诊断为经皮活检后恶性程度升级的报告产生范围,以及对LN自然病史认识的历史性改变。越来越多地认识到,并非所有的LN都相同,如多形性LCIS和繁茂型LCIS等不同变体具有不同的自然病史和升级为恶性的可能性。此外,越来越多人认识到适当的LN治疗依赖于严密的放射病理学关联。本综述详细介绍了ALH、经典型LCIS和LCIS变异体的成像特征和组织病理学性质;讨论了对该实体的历史理解的变化,导致其治疗管理方面产生混淆;并讨论了在经皮活检后进行放射病理学关联的重要性,以指导LN遇到时的适当管理步骤。除了LN诊断在短期内的升级和手术结果方面的影响外,还考察了LN诊断在风险发展后期乳腺癌方面的长期影响。©RSNA,2023本文的测验问题可通过在线学习中心获得。
Lobular neoplasia (LN) is a histopathologic entity that encompasses both lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH). Management of LN is known to be variable and institutionally dependent. The variability in approach after a diagnosis of LN at percutaneous breast biopsy derives in part from heterogeneity in the literature, resulting in a range of reported upgrade rates to malignancy after initial identification at percutaneous biopsy, and also from historical shifts in understanding of the natural history of LN. It has become increasingly recognized that not all LN is the same and that distinct variants of LN such as pleomorphic LCIS and florid LCIS have distinct natural histories and distinct likelihoods of upgrade to malignancy. In addition, it is also increasingly understood that appropriate management of LN relies on scrupulous radiologic-pathologic correlation. This review details the imaging features and histopathologic nature of ALH, classic-type LCIS, and the LCIS variants; addresses changes in the historical understanding of this entity contributing to confusion regarding its management; and discusses the importance of performing radiologic-pathologic correlation after percutaneous biopsy to help guide appropriate management steps when LN is encountered. In addition to the short-term implications of an LN diagnosis in terms of upgrade and surgical outcomes, the long-term implications of an LN diagnosis regarding risk of developing a later breast cancer are examined. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.