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Flat epithelial atypia: are we being too aggressive?
Breast Cancer Res Treat. 2020 Jan; 179(2):511-517.BC

Abstract

PURPOSE

The malignant upgrade rate of flat epithelial atypia (FEA) diagnosed on core needle biopsy varies between 0 and 30%. Excision versus observation with radiological follow-up for these lesions remains controversial. We hypothesize that the local rate of FEA is low and that close radiological surveillance is a reasonable treatment option for patients diagnosed with pure FEA on breast needle core needle biopsy.

METHODS

This study was a retrospective review of a prospectively collated provincial pathology database. Patients diagnosed with FEA alone on needle core biopsy between 2006 and 2016 were included in our analysis. Patients who had FEA present together with either in situ or invasive carcinoma within the same biopsy cores were excluded. Along with patient demographics, the size of the lesion on preoperative imaging, the method of extraction, and the presence of co-existing benign and malignant pathology on final excision biopsy were analyzed. An independent pathological review was performed to confirm our results and help reduce inter-observer bias.

RESULTS

The local rate of malignant upgrade when pure FEA is diagnosed on a breast needle core biopsy is 12%. Age at time of diagnosis, size of original lesion on mammogram, presence of atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia on core needle biopsy, the use of vacuum-assisted biopsy (VAB), or concordant imaging did not significantly correlate with malignant upgrade risk. None of the patients who were managed with radiological follow-up had malignant upgrade during follow-up. Patients undergoing radiological follow-up alone were more likely to have a VAB, concordant imaging, and no concurrent ADH.

CONCLUSION

Our local malignant upgrade rate is consistent with published literature. We suggest radiological follow-up is a safe alternative in patients with pure flat epithelial atypia and concordant imaging, particularly those patients with small lesions in which microcalcifications can be removed completely with vacuum-assisted biopsy.

Authors+Show Affiliations

Department of Surgery, University of Alberta, Edmonton, AB, Canada. adipasqu@ualberta.ca.Department of Laboratory Medicine, Covenant Health, Misericordia Community Hospital, University of Alberta, Edmonton, AB, Canada.Department of Laboratory Medicine, Covenant Health, Misericordia Community Hospital, University of Alberta, Edmonton, AB, Canada.Department of Surgery, Covenant Health, Misericordia Community Hospital, University of Alberta, Edmonton, AB, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31701300

Citation

DiPasquale, Ashley, et al. "Flat Epithelial Atypia: Are We Being Too Aggressive?" Breast Cancer Research and Treatment, vol. 179, no. 2, 2020, pp. 511-517.
DiPasquale A, Silverman S, Farag E, et al. Flat epithelial atypia: are we being too aggressive? Breast Cancer Res Treat. 2020;179(2):511-517.
DiPasquale, A., Silverman, S., Farag, E., & Peiris, L. (2020). Flat epithelial atypia: are we being too aggressive? Breast Cancer Research and Treatment, 179(2), 511-517. https://doi.org/10.1007/s10549-019-05481-9
DiPasquale A, et al. Flat Epithelial Atypia: Are We Being Too Aggressive. Breast Cancer Res Treat. 2020;179(2):511-517. PubMed PMID: 31701300.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Flat epithelial atypia: are we being too aggressive? AU - DiPasquale,Ashley, AU - Silverman,Sveta, AU - Farag,Erene, AU - Peiris,Lashan, Y1 - 2019/11/07/ PY - 2019/09/15/received PY - 2019/10/21/accepted PY - 2019/11/9/pubmed PY - 2020/9/30/medline PY - 2019/11/9/entrez KW - Breast neoplasm KW - Flat epithelial atypia KW - Treatment SP - 511 EP - 517 JF - Breast cancer research and treatment JO - Breast Cancer Res Treat VL - 179 IS - 2 N2 - PURPOSE: The malignant upgrade rate of flat epithelial atypia (FEA) diagnosed on core needle biopsy varies between 0 and 30%. Excision versus observation with radiological follow-up for these lesions remains controversial. We hypothesize that the local rate of FEA is low and that close radiological surveillance is a reasonable treatment option for patients diagnosed with pure FEA on breast needle core needle biopsy. METHODS: This study was a retrospective review of a prospectively collated provincial pathology database. Patients diagnosed with FEA alone on needle core biopsy between 2006 and 2016 were included in our analysis. Patients who had FEA present together with either in situ or invasive carcinoma within the same biopsy cores were excluded. Along with patient demographics, the size of the lesion on preoperative imaging, the method of extraction, and the presence of co-existing benign and malignant pathology on final excision biopsy were analyzed. An independent pathological review was performed to confirm our results and help reduce inter-observer bias. RESULTS: The local rate of malignant upgrade when pure FEA is diagnosed on a breast needle core biopsy is 12%. Age at time of diagnosis, size of original lesion on mammogram, presence of atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia on core needle biopsy, the use of vacuum-assisted biopsy (VAB), or concordant imaging did not significantly correlate with malignant upgrade risk. None of the patients who were managed with radiological follow-up had malignant upgrade during follow-up. Patients undergoing radiological follow-up alone were more likely to have a VAB, concordant imaging, and no concurrent ADH. CONCLUSION: Our local malignant upgrade rate is consistent with published literature. We suggest radiological follow-up is a safe alternative in patients with pure flat epithelial atypia and concordant imaging, particularly those patients with small lesions in which microcalcifications can be removed completely with vacuum-assisted biopsy. SN - 1573-7217 UR - https://www.unboundmedicine.com/medline/citation/31701300/Flat_epithelial_atypia:_are_we_being_too_aggressive DB - PRIME DP - Unbound Medicine ER -