乳腺良性增生性病变及高危病变病理学新认识

New sight of pathology for breast benign proliferative and high-risk lesions

所谓"乳腺良性增生性病变"包含乳腺一大组非常异质性的病变,对其基本认识在20世纪末已达成基本共识。乳腺高危病变是其中一组临床、病理学和生物学上的异质性疾病,这些疾病诊断之后长期持续性乳腺浸润性癌发生的危险性增加,但危险程度和水平各异,有些预示乳腺癌的发生风险,而有些则是乳腺癌的直接前驱病变,因此,临床意义与干预策略也不同。该组病变中非典型导管增生、非典型小叶增生和小叶原位癌双侧乳腺发生浸润性癌的相对危险性增加,小叶原位癌危险性更高并为非责任性前驱病变;导管原位癌被认为是真正的前驱病变,同侧最终发展为乳腺癌的风险较大。平坦上皮不典型性危险水平尚不明确。目前尚缺乏临床病理学和分子方面个体化危险性预测指标,这是未来个体化危险性处理战略的关键所在。

So called ＂breast benign proliferative lesions＂ are a large group of extremely heterogeneous diseases, and the principle consensus for their clinic-pathological features had been reached since the end of the last century. In which, the high-risk lesions of the breast represent a group of clinically, pathologically, and biologically heterogeneous lesions associated with an elevated risk of breast cancer development, although with varying degree of risk levels and different management strategies. Atypical dnctal hyperplasia and atypical lobular hyperplasia are associated with relative risk of breast cancer development. Lobular carcinoma in situ is both an indicator of an increased risk of breast cancer development and a non-obligated precursor lesion, while ductal carcinoma in situ represents a true precursor of invasive breast cancer. Up to date, clinicopathological features or molecular alterations identifying the individuals with high-risk breast lesions that will progress to invasive breast carcinoma remain to be identified, and the further study is needed.