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What is the significance of flat epithelial atypia and what are the management implications?
J Clin Pathol. 2011 Nov; 64(11):1001-4.JC

Abstract

AIMS

To assess the significance of flat epithelial atypia (FEA) on core biopsy by evaluating the proportion of cases upgraded to in-situ and invasive carcinoma on further sampling with vacuum-assisted biopsy (VAB) or diagnostic surgical biopsy.

METHODS

A retrospective analysis was performed of all core biopsies containing FEA and/or atypical intraductal proliferation (AIDP) in the pathology database from April 2008 to April 2010 (n=90). Before April 2009, the majority of core biopsies containing FEA and/or AIDP proceeded to surgical biopsy. From April 2009 onwards, a new patient management pathway was introduced incorporating VAB to sample core biopsies containing FEA and/or AIDP as an alternative to surgical biopsy.

RESULTS

Of 90 core biopsies, the following were identified: FEA only in 42%; FEA with concomitant AIDP in 21% and AIDP only in 37%. There was a stepwise increase in the proportion of cases upgraded to in-situ or invasive carcinoma: 19% in the FEA group; 29% in the FEA and AIDP group and 53% in the AIDP group. In the FEA-only group, one invasive tumour (grade 1 tubular carcinoma) and six cases of ductal carcinoma in situ were found.

CONCLUSION

The presence of FEA on core biopsy warrants further tissue sampling to ensure concomitant malignancy is not missed. Sampling with VAB provides sufficient tissue for histopathological evaluation, reducing the need for surgical biopsy. It is important that the utilisation of VAB is incorporated into a safe patient management pathway with careful multidisciplinary team discussion to ensure radiological-pathological concordance.

Authors+Show Affiliations

Department of Radiology, Leeds General Infirmary, Leeds, UK.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21725040

Citation

Rajan, Sabrina, et al. "What Is the Significance of Flat Epithelial Atypia and what Are the Management Implications?" Journal of Clinical Pathology, vol. 64, no. 11, 2011, pp. 1001-4.
Rajan S, Sharma N, Dall BJ, et al. What is the significance of flat epithelial atypia and what are the management implications? J Clin Pathol. 2011;64(11):1001-4.
Rajan, S., Sharma, N., Dall, B. J., & Shaaban, A. M. (2011). What is the significance of flat epithelial atypia and what are the management implications? Journal of Clinical Pathology, 64(11), 1001-4. https://doi.org/10.1136/jclinpath-2011-200176
Rajan S, et al. What Is the Significance of Flat Epithelial Atypia and what Are the Management Implications. J Clin Pathol. 2011;64(11):1001-4. PubMed PMID: 21725040.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What is the significance of flat epithelial atypia and what are the management implications? AU - Rajan,Sabrina, AU - Sharma,Nisha, AU - Dall,Barbara J G, AU - Shaaban,Abeer M, Y1 - 2011/07/01/ PY - 2011/7/5/entrez PY - 2011/7/5/pubmed PY - 2012/1/14/medline SP - 1001 EP - 4 JF - Journal of clinical pathology JO - J Clin Pathol VL - 64 IS - 11 N2 - AIMS: To assess the significance of flat epithelial atypia (FEA) on core biopsy by evaluating the proportion of cases upgraded to in-situ and invasive carcinoma on further sampling with vacuum-assisted biopsy (VAB) or diagnostic surgical biopsy. METHODS: A retrospective analysis was performed of all core biopsies containing FEA and/or atypical intraductal proliferation (AIDP) in the pathology database from April 2008 to April 2010 (n=90). Before April 2009, the majority of core biopsies containing FEA and/or AIDP proceeded to surgical biopsy. From April 2009 onwards, a new patient management pathway was introduced incorporating VAB to sample core biopsies containing FEA and/or AIDP as an alternative to surgical biopsy. RESULTS: Of 90 core biopsies, the following were identified: FEA only in 42%; FEA with concomitant AIDP in 21% and AIDP only in 37%. There was a stepwise increase in the proportion of cases upgraded to in-situ or invasive carcinoma: 19% in the FEA group; 29% in the FEA and AIDP group and 53% in the AIDP group. In the FEA-only group, one invasive tumour (grade 1 tubular carcinoma) and six cases of ductal carcinoma in situ were found. CONCLUSION: The presence of FEA on core biopsy warrants further tissue sampling to ensure concomitant malignancy is not missed. Sampling with VAB provides sufficient tissue for histopathological evaluation, reducing the need for surgical biopsy. It is important that the utilisation of VAB is incorporated into a safe patient management pathway with careful multidisciplinary team discussion to ensure radiological-pathological concordance. SN - 1472-4146 UR - https://www.unboundmedicine.com/medline/citation/21725040/What_is_the_significance_of_flat_epithelial_atypia_and_what_are_the_management_implications L2 - https://jcp.bmj.com/lookup/pmidlookup?view=long&pmid=21725040 DB - PRIME DP - Unbound Medicine ER -