Tags

Type your tag names separated by a space and hit enter

Flat Epithelial Atypia in Breast Core Needle Biopsies With Radiologic-Pathologic Concordance: Is Excision Necessary?
Am J Surg Pathol. 2020 02; 44(2):182-190.AJ

Abstract

Flat epithelial atypia (FEA) is an alteration of terminal duct lobular units by a proliferation of ductal epithelium with low-grade atypia. No consensus exists on whether the diagnosis of FEA in core needle biopsy (CNB) requires excision (EXC). We retrospectively identified all in-house CNBs obtained between January 2012 and July 2018 with FEA. We reviewed all CNB slides and assessed radiologic-pathologic concordance. An upgrade was defined as invasive carcinoma (IC) and/or ductal carcinoma in situ in the EXC. The EXC slides of all upgraded cases were rereviewed. Out of ∼15,700 consecutive CNBs in the study period, 106 CNBs from 106 patients yielded FEA alone or with classic lobular neoplasia (LN). We excluded 52 CNBs (40 patients with prior/concurrent carcinoma and 12 without EXC). After rereview, we reclassified 14 cases (2 marked nuclear atypia, 10 focal atypical ductal hyperplasia, 2 benign). The final FEA study cohort consisted of 40 CNBs from 40 women. The CNB targeted mammographic calcifications in 36 (90%) cases, magnetic resonance imaging nonmass enhancement in 3 (8%), and 1 (2%) sonographic mass. All CNBs were deemed radiologic-pathologic concordant. FEA was present alone in 34 CNBs and with LN in 6. EXC yielded 2 low-grade IC, each spanning <2 mm, identified in tissue sections without biopsy site changes. The remaining 38 cases had no upgrade. Classic LN did not affect the upgrade. The upgrade rate of FEA was 5%; both minute, low-grade "incidental" IC. We conclude that nonsurgical management may be considered in patients without prior/concurrent carcinoma and radiologic-pathologic concordant CNB diagnosis of FEA.

Links

PMC Free PDF

Authors+Show Affiliations

Grabenstetter A
Departments of Pathology.
Brennan S
Radiology.
Salagean ED
Departments of Pathology.
Morrow M
Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Brogi E
Departments of Pathology.

MeSH

AdultAgedBiopsy, Large-Core NeedleBreastBreast NeoplasmsCarcinoma, Ductal, BreastCarcinoma, Intraductal, NoninfiltratingCarcinoma, LobularConservative TreatmentFemaleFollow-Up StudiesHumansMagnetic Resonance ImagingMammographyMastectomyMiddle AgedPrecancerous ConditionsRetrospective StudiesRisk AssessmentUltrasonography, Mammary

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31609784

Citation

Grabenstetter, Anne, et al. "Flat Epithelial Atypia in Breast Core Needle Biopsies With Radiologic-Pathologic Concordance: Is Excision Necessary?" The American Journal of Surgical Pathology, vol. 44, no. 2, 2020, pp. 182-190.
Grabenstetter A, Brennan S, Salagean ED, et al. Flat Epithelial Atypia in Breast Core Needle Biopsies With Radiologic-Pathologic Concordance: Is Excision Necessary? Am J Surg Pathol. 2020;44(2):182-190.
Grabenstetter, A., Brennan, S., Salagean, E. D., Morrow, M., & Brogi, E. (2020). Flat Epithelial Atypia in Breast Core Needle Biopsies With Radiologic-Pathologic Concordance: Is Excision Necessary? The American Journal of Surgical Pathology, 44(2), 182-190. https://doi.org/10.1097/PAS.0000000000001385
Grabenstetter A, et al. Flat Epithelial Atypia in Breast Core Needle Biopsies With Radiologic-Pathologic Concordance: Is Excision Necessary. Am J Surg Pathol. 2020;44(2):182-190. PubMed PMID: 31609784.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Flat Epithelial Atypia in Breast Core Needle Biopsies With Radiologic-Pathologic Concordance: Is Excision Necessary? AU - Grabenstetter,Anne, AU - Brennan,Sandra, AU - Salagean,Elena D, AU - Morrow,Monica, AU - Brogi,Edi, PY - 2019/10/15/pubmed PY - 2020/5/14/medline PY - 2019/10/15/entrez SP - 182 EP - 190 JF - The American journal of surgical pathology JO - Am J Surg Pathol VL - 44 IS - 2 N2 - Flat epithelial atypia (FEA) is an alteration of terminal duct lobular units by a proliferation of ductal epithelium with low-grade atypia. No consensus exists on whether the diagnosis of FEA in core needle biopsy (CNB) requires excision (EXC). We retrospectively identified all in-house CNBs obtained between January 2012 and July 2018 with FEA. We reviewed all CNB slides and assessed radiologic-pathologic concordance. An upgrade was defined as invasive carcinoma (IC) and/or ductal carcinoma in situ in the EXC. The EXC slides of all upgraded cases were rereviewed. Out of ∼15,700 consecutive CNBs in the study period, 106 CNBs from 106 patients yielded FEA alone or with classic lobular neoplasia (LN). We excluded 52 CNBs (40 patients with prior/concurrent carcinoma and 12 without EXC). After rereview, we reclassified 14 cases (2 marked nuclear atypia, 10 focal atypical ductal hyperplasia, 2 benign). The final FEA study cohort consisted of 40 CNBs from 40 women. The CNB targeted mammographic calcifications in 36 (90%) cases, magnetic resonance imaging nonmass enhancement in 3 (8%), and 1 (2%) sonographic mass. All CNBs were deemed radiologic-pathologic concordant. FEA was present alone in 34 CNBs and with LN in 6. EXC yielded 2 low-grade IC, each spanning <2 mm, identified in tissue sections without biopsy site changes. The remaining 38 cases had no upgrade. Classic LN did not affect the upgrade. The upgrade rate of FEA was 5%; both minute, low-grade "incidental" IC. We conclude that nonsurgical management may be considered in patients without prior/concurrent carcinoma and radiologic-pathologic concordant CNB diagnosis of FEA. SN - 1532-0979 UR - https://www.unboundmedicine.com/medline/citation/31609784/Flat_Epithelial_Atypia_in_Breast_Core_Needle_Biopsies_With_Radiologic_Pathologic_Concordance:_Is_Excision_Necessary DB - PRIME DP - Unbound Medicine ER -