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恶性可能未定的乳腺病变（B3）第二届国际共识会议于2018年3月在瑞士苏黎世举行，由国际乳腺超声学院组织，对于共识推荐意见进行了重新评估。 2018年11月30日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表瑞士日内瓦大学医院、巴登州立医院、苏黎世乳腺中心、伯尔尼大学医院、巴塞尔大学、圣加仑州立医院、恩格利德医院、苏黎世大学医院、乌伊蒂孔瓦尔德格医院、英国伦敦大学圣乔治医院、美国纽约纪念医院斯隆凯特林癌症中心、德国奥斯纳布吕克马里安医院、迪特里希朋霍费尔医院、慕尼黑大学、奥地利维也纳医科大学、意大利博洛尼亚大学、法国巴黎文理研究大学居里研究所的研究报告，评估了2016年第一次苏黎世共识会议对B3病变管理推荐建议对日常实践的影响，回顾了目前关于活检推荐意见的文献。 结果，2018年B3病变管理共识推荐意见基本不变：
该研究对记录3万多例手术的瑞士微创乳腺活检（MIBB）数据库进行分析，对于真空辅助活检诊断病变，推荐密切监测的比例日趋提高：
因此，该研究结果表明，对于大多数B3病变（导管异型增生和叶状肿瘤除外），结合真空辅助活检的微创处理仍然适合作为一线开放手术切除的替代方案，但是需要密切监测，尤其对于小叶肿瘤。 Breast Cancer Res Treat. 2018 Nov 30. Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Christoph J. Rageth, Elizabeth A. M. O'Flynn, Katja Pinker, Rahel A. Kubik-Huch, Alexander Mundinger, Thomas Decker, Christoph Tausch, Florian Dammann, Pascal A. Baltzer, Eva Maria Fallenberg, Maria P. Foschini, Sophie Dellas, Michael Knauer, Caroline Malhaire, Martin Sonnenschein, Andreas Boos, Elisabeth Morris, Zsuzsanna Varga. Hopitaux Universitaires de Genève, Geneva, Switzerland; St George's University Hospitals NHS Foundation Trust, London, UK; Memorial Sloan Kettering Cancer Center, New York, USA; Kantonsspital Baden, Baden, Switzerland; Zentrum Radiologie der Niels-Stensen-Kliniken; Marienhospital Osnabrück, Osnabrück, Germany; Institut für Pathologie am Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany; Brust-Zentrum Zürich, Zurich, Switzerland; University Hospital Bern, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; Ludwig Maximilian University Munich, Munich, Germany; University of Bologna, Bologna, Italy; University of Basel, Basel, Switzerland; Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Institut Curie, PSL Research University, Paris, France; Klinik Engeried, Lindenhofgruppe AG, Bern, Switzerland; University Hospital Zurich, Zurich, Switzerland; Uitikon Waldegg, Switzerland. PURPOSE: The second International Consensus Conference on B3 lesions was held in Zurich, Switzerland, in March 2018, organized by the International Breast Ultrasound School to re-evaluate the consensus recommendations. METHODS: This study (1) evaluated how management recommendations of the first Zurich Consensus Conference of 2016 on B3 lesions had influenced daily practice and (2) reviewed current literature towards recommendations to biopsy. RESULTS: In 2018, the consensus recommendations for management of B3 lesions remained almost unchanged: For flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL) and radial scars (RS) diagnosed on core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB), excision by VAB in preference to open surgery, and for atypical ductal hyperplasia (ADH) and phyllodes tumors (PT) diagnosed at VAB or CNB, first-line open surgical excision (OE) with follow-up surveillance imaging for 5 years. Analyzing the Database of the Swiss Minimally Invasive Breast Biopsies (MIBB) with more than 30,000 procedures recorded, there was a significant increase in recommending more frequent surveillance of LN [65% in 2018 vs. 51% in 2016 (p=0.004)], FEA (72% in 2018 vs. 62% in 2016 (p=0.005)), and PL [(76% in 2018 vs. 70% in 2016 (p=0.04)] diagnosed on VAB. A trend to more frequent surveillance was also noted also for RS [77% in 2018 vs. 67% in 2016 (p=0.07)]. CONCLUSIONS: Minimally invasive management of B3 lesions (except ADH and PT) with VAB continues to be appropriate as an alternative to first-line OE in most cases, but with more frequent surveillance, especially for LN. KEYWORDS: B3 lesions Vacuum-assisted biopsy Consensus Breast Uncertain malignant potential Breast surgery DOI: 10.1007/s10549-018-05071-1
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