对各种组织病理学、临​​床和影像学参数进行了评估，以确定被诊断患有不确定恶性潜能病变（B3 或 BIRADS 3/4A 病变）的女性子集，这些女性可以安全地进行观察，而不是进行手术切除治疗，对临床影响很小实践。手术的主要原因是为了排除升级为导管原位癌或浸润性乳腺癌，这种情况发生在高达 30% 的患者中。我们假设基质免疫微环境可以表明与导管 B3 病变相关的癌症的存在，并且可以通过计数淋巴细胞作为升级的预测生物标志物在活检中检测到这一点。在升级的导管和乳头 B3 病变中观察到周围特化基质中的淋巴细胞数量高于未升级的病变（p<<0.01，负二项式模型，n=307）。我们开发了一个使用淋巴细胞结合年龄和病变类型的模型，该模型可预测升级，曲线下面积为 0.82 [95% 置信区间 0.77-0.87]。该模型可以以高灵敏度识别一些有升级风险的患者，但特异性有限。评估包括基质淋巴细胞在内的肿瘤微环境可能有助于减少临床上不必要的手术，但需要额外的预测功能。© 2024。作者。

Various histopathological, clinical and imaging parameters have been evaluated to identify a subset of women diagnosed with lesions with uncertain malignant potential (B3 or BIRADS 3/4A lesions) who could safely be observed rather than being treated with surgical excision, with little impact on clinical practice. The primary reason for surgery is to rule out an upgrade to either ductal carcinoma in situ or invasive breast cancer, which occurs in up to 30% of patients. We hypothesised that the stromal immune microenvironment could indicate the presence of carcinoma associated with a ductal B3 lesion and that this could be detected in biopsies by counting lymphocytes as a predictive biomarker for upgrade. A higher number of lymphocytes in the surrounding specialised stroma was observed in upgraded ductal and papillary B3 lesions than non-upgraded (p < 0.01, negative binomial model, n = 307). We developed a model using lymphocytes combined with age and the type of lesion, which was predictive of upgrade with an area under the curve of 0.82 [95% confidence interval 0.77-0.87]. The model can identify some patients at risk of upgrade with high sensitivity, but with limited specificity. Assessing the tumour microenvironment including stromal lymphocytes may contribute to reducing unnecessary surgeries in the clinic, but additional predictive features are needed.© 2024. The Author(s).