ANATOMIC INDICATORS (HISTOLOGIC AND CYTOLOGIC) OF INCREASED BREAST-CANCER RISK
ANATOMIC INDICATORS (HISTOLOGIC AND CYTOLOGIC) OF INCREASED BREAST-CANCER RISK
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DOI：
10.1007/bf00666428
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发表时间：
1993-01-01
影响因子：
3.8
通讯作者：
DUPONT, WD
中科院分区：
文献类型：
--
作者：
PAGE, DL;DUPONT, WD
乳腺癌风险增加的解剖学指标通常被确定为增生性病变，类似于其他身体部位。其中大多数已被证明表明，在任何乳房的任何地方，后来的风险增加，因此应被视为风险增加的指标或标志。不幸的是，这些很大程度上是通过当前的检测方法偶然发现的。具体的组织学和细胞学的定义这些病变的标准已被评估其诊断和结果变量的再现性。几项研究一致认为，至少中度增生的常见模式表明，晚期乳腺癌的风险增加了一般人群的1.5至2倍。非典型增生的具体定义的例子，相对罕见的病变，发现在4-5%的活检（取决于检测方法），并承认在控制年龄和随访时间的一般人群的4-5倍的范围内的风险。因此，几项队列研究采用可比的解剖学病变定义标准发现了相似的临床结局。其他组织学定义方法在非“非典型"和其他形式的增生之间产生了较小程度的分离。虽然我们不清楚我们处理的是连续变量还是离散的组织学/细胞学变量，但很明显，当使用联合标准时，可以获得更高程度的预测性。其他相关的风险特征包括最主要的家族史，当存在不典型增生时，其风险比单独使用任何一种都要高。其他方法检测这些不同的病变，如细针穿刺细胞学，还没有得到证实。真正的非专性乳腺癌的前体可能局限于低级别和非粉刺性乳腺导管癌。
Anatomic indicators of increased breast cancer risk have regularly been identified as hyperplastic lesions, analogous to other body sites. Most of these have been shown to indicate a later increased risk anywhere in either breast and should thus be regarded as indicators or markers of increased risk. Unfortunately, these are largely identified incidentally to current methods of detection. Specific combined histologic and cytologic criteria for the definition of these lesions have been evaluated for both their reproducibility of diagnosis and outcome variables. Several studies agree that usual patterns of hyperplasia of at least moderate degree indicate an increased risk of later breast carcinoma between 1.5 and 2 times that of the general population. The specifically defined examples of atypical hyperplasia, lesions of relative rarity, are found in 4-5% of biopsies (depending upon method of detection) and recognize a risk in the range of 4-5 times that of the general population controlled for age and duration of follow-up. Thus, several cohort studies using comparable criteria for definition of the anatomic lesions have found similar clinical outcomes.Other approaches to histologic definition have produced a lesser degree of separation between the non ''atypical'' and other forms of hyperplasia. Although it is not clear whether we are dealing with continuous variables or discrete histologic/cytologic variables, it is clear that when combined criteria are used, a greater degree of predictability is obtained.Other related risk features include most predominantly family history, which when present with atypical hyperplasia indicates an increased risk beyond that of either alone. Other means of detection of these various lesions, such as fine needle aspiration cytology, have not been verified.True non-obligate precursors of breast cancer are probably confined to low grade and non-comedo ductal carcinomas of the breast.