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Flat epithelial atypia: conservative management of patients without residual microcalcifications post-vacuum-assisted breast biopsy.
Br J Radiol. 2018 Jan; 91(1081):20170484.BJ

Abstract

OBJECTIVE

To determine the malignancy rate (defined in this study as stability or absence of malignancy developed on close imaging follow-up post-biopsy) of conservative management in patients with a vacuum-assisted breast biopsy (VAB) diagnosis of flat epithelial atypia (FEA), performed on single group of microcalcifications, completely removed during procedure.

METHODS

This is a retrospective, monocentric, observational study, approved by IRB. Inclusion criteria were: VAB performed on a single group of microcalcifications; the absence of residual calcifications post-VAB; diagnosis of isolated FEA as the most advanced proliferative lesion; radiological follow-up at least of 12 months. The personal history of breast cancer or other high-risk lesions was an exclusion criteria. The patients enrolled were conservatively managed, without surgical excision, through close follow-up: the first two mammographies performed with an interval of 6 months after biopsy, followed by annual mammographic and clinical checks.

RESULTS

48 consecutive patients were enrolled in the study, all females, with age range of 39-76 years (mean 53,3 years) and radiological follow-up range of 13-75 months (mean 41.5 months). All the lesions were classified as BI-RADS 4b. The diameter range of the group of calcifications was 3-10 mm (mean 5, 6 mm). In each patient, 7 to 15 samples (mean 11) were obtained. Among all the patients, there was only one case (2%) of new microcalcifications, developed in the same breast, 26 months after and 8 mm from the site of previous VAB, and interpreted as ADH at surgical excision. All the checks of the other patients were negative.

CONCLUSION

Even with a limited follow-up, we found a malignancy rate lower than 2%, through a defined population. Further studies with bigger number of patients and extended follow-up are needed to reinforce this hypothesis. Advances in knowledge: Surgical excision may not be necessary in patients with VAB diagnosis of isolated FEA, without residual microcalcifications post-procedure and considered concordant with the mammographic presentation, considering the low rate of malignancy at subsequent follow-ups.

Authors+Show Affiliations

1 Department of Radiology, University of Genoa , Genoa , Italy.1 Department of Radiology, University of Genoa , Genoa , Italy.2 Department of Radiology, Ospedale San Bartolomeo , Sarzana , Italy.3 Department of Radiology, Policlinico San Martino , Genoa , Italy.3 Department of Radiology, Policlinico San Martino , Genoa , Italy.4 Department of Pathologic Anatomy, Policlinico San Martino , Genoa , Italy.3 Department of Radiology, Policlinico San Martino , Genoa , Italy.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

29072858

Citation

Schiaffino, Simone, et al. "Flat Epithelial Atypia: Conservative Management of Patients Without Residual Microcalcifications Post-vacuum-assisted Breast Biopsy." The British Journal of Radiology, vol. 91, no. 1081, 2018, p. 20170484.
Schiaffino S, Gristina L, Villa A, et al. Flat epithelial atypia: conservative management of patients without residual microcalcifications post-vacuum-assisted breast biopsy. Br J Radiol. 2018;91(1081):20170484.
Schiaffino, S., Gristina, L., Villa, A., Tosto, S., Monetti, F., Carli, F., & Calabrese, M. (2018). Flat epithelial atypia: conservative management of patients without residual microcalcifications post-vacuum-assisted breast biopsy. The British Journal of Radiology, 91(1081), 20170484. https://doi.org/10.1259/bjr.20170484
Schiaffino S, et al. Flat Epithelial Atypia: Conservative Management of Patients Without Residual Microcalcifications Post-vacuum-assisted Breast Biopsy. Br J Radiol. 2018;91(1081):20170484. PubMed PMID: 29072858.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Flat epithelial atypia: conservative management of patients without residual microcalcifications post-vacuum-assisted breast biopsy. AU - Schiaffino,Simone, AU - Gristina,Licia, AU - Villa,Alessandro, AU - Tosto,Simona, AU - Monetti,Francesco, AU - Carli,Franca, AU - Calabrese,Massimo, Y1 - 2017/11/09/ PY - 2017/10/27/pubmed PY - 2017/12/28/medline PY - 2017/10/27/entrez SP - 20170484 EP - 20170484 JF - The British journal of radiology JO - Br J Radiol VL - 91 IS - 1081 N2 - OBJECTIVE: To determine the malignancy rate (defined in this study as stability or absence of malignancy developed on close imaging follow-up post-biopsy) of conservative management in patients with a vacuum-assisted breast biopsy (VAB) diagnosis of flat epithelial atypia (FEA), performed on single group of microcalcifications, completely removed during procedure. METHODS: This is a retrospective, monocentric, observational study, approved by IRB. Inclusion criteria were: VAB performed on a single group of microcalcifications; the absence of residual calcifications post-VAB; diagnosis of isolated FEA as the most advanced proliferative lesion; radiological follow-up at least of 12 months. The personal history of breast cancer or other high-risk lesions was an exclusion criteria. The patients enrolled were conservatively managed, without surgical excision, through close follow-up: the first two mammographies performed with an interval of 6 months after biopsy, followed by annual mammographic and clinical checks. RESULTS: 48 consecutive patients were enrolled in the study, all females, with age range of 39-76 years (mean 53,3 years) and radiological follow-up range of 13-75 months (mean 41.5 months). All the lesions were classified as BI-RADS 4b. The diameter range of the group of calcifications was 3-10 mm (mean 5, 6 mm). In each patient, 7 to 15 samples (mean 11) were obtained. Among all the patients, there was only one case (2%) of new microcalcifications, developed in the same breast, 26 months after and 8 mm from the site of previous VAB, and interpreted as ADH at surgical excision. All the checks of the other patients were negative. CONCLUSION: Even with a limited follow-up, we found a malignancy rate lower than 2%, through a defined population. Further studies with bigger number of patients and extended follow-up are needed to reinforce this hypothesis. Advances in knowledge: Surgical excision may not be necessary in patients with VAB diagnosis of isolated FEA, without residual microcalcifications post-procedure and considered concordant with the mammographic presentation, considering the low rate of malignancy at subsequent follow-ups. SN - 1748-880X UR - https://www.unboundmedicine.com/medline/citation/29072858/Flat_epithelial_atypia:_conservative_management_of_patients_without_residual_microcalcifications_post_vacuum_assisted_breast_biopsy_ DB - PRIME DP - Unbound Medicine ER -