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Flat epithelial atypia in directional vacuum-assisted biopsy of breast microcalcifications: surgical excision may not be necessary.
Mod Pathol. 2018 07; 31(7):1097-1106.MP

Abstract

The aim of this study was to analyze the clinicopathological features of patients with flat epithelial atypia, diagnosed in directional vacuum-assisted biopsy targeting microcalcifications, to identify upgrade rate to in situ ductal or invasive breast carcinoma, and determine factors predicting carcinoma in the subsequent excision. We retrospectively evaluated the histological, clinical, and mammographic features of 69 cases from 65 women, with directional vacuum-assisted biopsy-diagnosed flat epithelial atypia with or without atypical ductal hyperplasia or atypical lobular hyperplasia, which underwent subsequent surgical excision. The extent and percentage of microcalcifications sampled by directional vacuum-assisted biopsy were evaluated by mammography. All biopsy and surgical excision slides were reviewed. The age of the women ranged from 40 to 85 years (mean 57 years). All patients presented with mammographically detected microcalcifications only, except in one case that had associated architectural distortion. Extent of calcifications ranged from <1 cm (n = 47), 1-3 cm (n = 15) to > 3 cm (n = 6), and no measurement (n = 1). A mean of 11 cores (range 6-25) was obtained from each lesion. Post-biopsy mammogram revealed >90% removal of calcifications in 81% of cases. Pure flat epithelial atypia represented nearly two-thirds of directional vacuum-assisted biopsy specimens (n = 43, 62%), while flat epithelial atypia coexisted with atypical ductal hyperplasia (18 cases, 26%), or atypical lobular hyperplasia (8 cases, 12%). Upon excision, none of the cases were upgraded to in situ ductal or invasive breast cancer. In one case, however, an incidental, tubular carcinoma (4 mm) was found away from biopsy site. Excluding this case, the upgrade rate was 0%. Our study adds to the growing evidence that diagnosis of flat epithelial atypia on directional vacuum-assisted biopsy for microcalcifications as the only imaging finding is not associated with a significant upgrade to carcinoma on excision, and therefore, excision may not be necessary. Additionally, excision may not be necessary for flat epithelial atypia with atypical ductal hyperplasia limited to ≤2 terminal duct-lobular units, if at least 90% of calcifications have been removed on biopsy.

Authors+Show Affiliations

Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77098, USA.Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77098, USA. NSneige@houstonmethodist.org.The Methodist Breast Center Imaging, Houston Methodist Hospital, Houston, TX, 77098, USA.Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77098, USA.The Methodist Breast Center Imaging, Houston Methodist Hospital, Houston, TX, 77098, USA.Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77098, USA.Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77098, USA.Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77098, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29467479

Citation

McCroskey, Zulfia, et al. "Flat Epithelial Atypia in Directional Vacuum-assisted Biopsy of Breast Microcalcifications: Surgical Excision May Not Be Necessary." Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, vol. 31, no. 7, 2018, pp. 1097-1106.
McCroskey Z, Sneige N, Herman CR, et al. Flat epithelial atypia in directional vacuum-assisted biopsy of breast microcalcifications: surgical excision may not be necessary. Mod Pathol. 2018;31(7):1097-1106.
McCroskey, Z., Sneige, N., Herman, C. R., Miller, R. A., Venta, L. A., Ro, J. Y., Schwartz, M. R., & Ayala, A. G. (2018). Flat epithelial atypia in directional vacuum-assisted biopsy of breast microcalcifications: surgical excision may not be necessary. Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, 31(7), 1097-1106. https://doi.org/10.1038/s41379-018-0035-5
McCroskey Z, et al. Flat Epithelial Atypia in Directional Vacuum-assisted Biopsy of Breast Microcalcifications: Surgical Excision May Not Be Necessary. Mod Pathol. 2018;31(7):1097-1106. PubMed PMID: 29467479.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Flat epithelial atypia in directional vacuum-assisted biopsy of breast microcalcifications: surgical excision may not be necessary. AU - McCroskey,Zulfia, AU - Sneige,Nour, AU - Herman,Carolyn R, AU - Miller,Ross A, AU - Venta,Luz A, AU - Ro,Jae Y, AU - Schwartz,Mary R, AU - Ayala,Alberto G, Y1 - 2018/02/21/ PY - 2017/10/15/received PY - 2018/01/07/accepted PY - 2018/01/05/revised PY - 2018/2/23/pubmed PY - 2019/6/14/medline PY - 2018/2/23/entrez SP - 1097 EP - 1106 JF - Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc JO - Mod Pathol VL - 31 IS - 7 N2 - The aim of this study was to analyze the clinicopathological features of patients with flat epithelial atypia, diagnosed in directional vacuum-assisted biopsy targeting microcalcifications, to identify upgrade rate to in situ ductal or invasive breast carcinoma, and determine factors predicting carcinoma in the subsequent excision. We retrospectively evaluated the histological, clinical, and mammographic features of 69 cases from 65 women, with directional vacuum-assisted biopsy-diagnosed flat epithelial atypia with or without atypical ductal hyperplasia or atypical lobular hyperplasia, which underwent subsequent surgical excision. The extent and percentage of microcalcifications sampled by directional vacuum-assisted biopsy were evaluated by mammography. All biopsy and surgical excision slides were reviewed. The age of the women ranged from 40 to 85 years (mean 57 years). All patients presented with mammographically detected microcalcifications only, except in one case that had associated architectural distortion. Extent of calcifications ranged from <1 cm (n = 47), 1-3 cm (n = 15) to > 3 cm (n = 6), and no measurement (n = 1). A mean of 11 cores (range 6-25) was obtained from each lesion. Post-biopsy mammogram revealed >90% removal of calcifications in 81% of cases. Pure flat epithelial atypia represented nearly two-thirds of directional vacuum-assisted biopsy specimens (n = 43, 62%), while flat epithelial atypia coexisted with atypical ductal hyperplasia (18 cases, 26%), or atypical lobular hyperplasia (8 cases, 12%). Upon excision, none of the cases were upgraded to in situ ductal or invasive breast cancer. In one case, however, an incidental, tubular carcinoma (4 mm) was found away from biopsy site. Excluding this case, the upgrade rate was 0%. Our study adds to the growing evidence that diagnosis of flat epithelial atypia on directional vacuum-assisted biopsy for microcalcifications as the only imaging finding is not associated with a significant upgrade to carcinoma on excision, and therefore, excision may not be necessary. Additionally, excision may not be necessary for flat epithelial atypia with atypical ductal hyperplasia limited to ≤2 terminal duct-lobular units, if at least 90% of calcifications have been removed on biopsy. SN - 1530-0285 UR - https://www.unboundmedicine.com/medline/citation/29467479/Flat_epithelial_atypia_in_directional_vacuum_assisted_biopsy_of_breast_microcalcifications:_surgical_excision_may_not_be_necessary_ L2 - https://doi.org/10.1038/s41379-018-0035-5 DB - PRIME DP - Unbound Medicine ER -