A retrospective study of columnar alteration with prominent apical snouts and secretions and the association with cancer

Guerra-Wallace, Melissa M.; Christensen, Wayne N.; White, Richard L.

doi:10.1016/j.amjsurg.2004.06.037

Cited by 71 publications

(48 citation statements)

References 6 publications

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“…As in previous reports, we confirm that almost all patients (92%) with pure FEA underwent needle biopsy for calcifications [15,16,23]. Like other studies, FEA is detected in association with ADH (30% in this study) and/or lobular neoplasia (10%) on CNB and with DCIS (10%) and IC (3%) on excisional biopsy [4,6,12,15,16,24,25]. The diagnosis and identification of FEA, especially on CNB, represents a challenge to surgical pathologists with inter-and intra-observer variability [26,27].…”

Section: Discussionsupporting

confidence: 91%

“…Due to a lack of standardized terminology, FEA and ADH are sometimes poorly differentiated on pathological examination [4]. As defined by the WHO [3], FEA is an "intraductal alteration characterized by replacement of the native epithelial cells by a single or 3 to 5 layers of mildly atypical cells.…”

Section: As Defined By the World Health Organization (Who) Working Grmentioning

confidence: 99%

“…A few small studies (less than 40 cases) (almost all published in abstract form) were confused and showed a more advanced lesion, either DCIS or IC, in between 0 and 30% of cases of subsequent surgical excision after FEA diagnosed with CNB [4,[15][16][17][18][19][20][21]. Thus, published studies are rare, lack standardized terminology and sometimes confuse FEA and ADH on pathology [4,16].…”

Section: As Defined By the World Health Organization (Who) Working Grmentioning

confidence: 99%

See 2 more Smart Citations

Pure flat epithelial atypia (DIN 1a) on core needle biopsy: study of 60 biopsies with follow-up surgical excision

Lavoué

Roger

Poilblanc³

et al. 2010

Breast Cancer Res Treat

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Section: Discussionsupporting

confidence: 91%

Section: As Defined By the World Health Organization (Who) Working Grmentioning

confidence: 99%

Section: As Defined By the World Health Organization (Who) Working Grmentioning

confidence: 99%

See 1 more Smart Citation

Pure flat epithelial atypia (DIN 1a) on core needle biopsy: study of 60 biopsies with follow-up surgical excision

Lavoué

Roger

Poilblanc³

et al. 2010

Breast Cancer Res Treat

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“…8,16,39 For columnar cell lesions with atypia, most advice a surgical excision biopsy because several large studies showed more significant lesions in up to 33% in the subsequent resections. 16,38,[40][41][42][43][44] Next to the finding of more columnar cell lesions without atypia, also more tumors (including ductal carcinoma in situ and invasive carcinoma) in core needle biopsies were diagnosed per mammogram with full-field digital mammography, showing that not only more irrelevant lesions were biopsied.…”

Section: Discussionmentioning

confidence: 99%

Digital mammography: more microcalcifications, more columnar cell lesions without atypia

et al. 2011

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The incidence of columnar cell lesions in breast core needle biopsies since full-field digital mammography in comparison with screen-filmed mammography was analyzed. As tiny microcalcifications characterize columnar cell lesions at mammography, we hypothesized that more columnar cell lesions are diagnosed since full-field digital mammography due to its higher sensitivity for microcalcifications. In all, 3437 breast core needle biopsies performed in three hospitals and resulting from in total 55 159 mammographies were revised: 1424 taken in the screen-filmed mammography and 2013 in the full-field digital mammography period. Between the screen-filmed mammography and full-field digital mammography periods, we compared the proportion of mammographies that led to core needle biopsies, the mammographic indication for core needle biopsies (density, microcalcifications, or both) and the proportion of columnar cell lesions with or without atypia. The columnar cell lesions were graded according to Schnitt, and we included atypical ductal hyperplasia arising in the context of columnar cell lesions. Proportions were compared using v 2 tests and prevalence ratios were adjusted for age and hospital. We found that more core needle biopsies per mammogram were taken in the full-field digital mammography period (7.6%) compared with the screen-filmed mammography period (5.0%, Po0.0001). Microcalcifications were more often diagnosed with full-field digital mammography than with screen-filmed mammography (adjusted prevalence ratio: 1.14, confidence interval 95%: 1.01-1.28). Core needle biopsies from the full-field digital mammography era showed more columnar cell lesions (10.8%) than those from the screen-filmed mammography era (4.9%; adjusted prevalence ratio: 1.93, confidence interval 95%: 1.48-2.51), particularly due to more columnar cell lesions without atypia (8.2% respectively 2.8%) while the proportion of columnar cell lesions with atypia remained nearly constant (2.0 vs 2.6%). In conclusion, since the implementation of full-field digital mammography, more microcalcifications are seen at mammography, more often resulting in core needle biopsies, which especially yields more columnar cell lesions without atypia.

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“…16,17 In a prior series from our institution, we reported a series of 31 cases from 1998 to 2003, with available follow-up excisions, 4 (12.9%) of which contained carcinoma. 21 That study predated the WHO classification of flat epithelial atypia, 1 and we now report the frequency of carcinoma in excision specimens after a diagnosis of flat epithelial atypia on core biopsy for a subsequent 9-year period (2004-2013).…”

mentioning

confidence: 88%

Management of flat epithelial atypia on breast core biopsy may be individualized based on correlation with imaging studies

et al. 2015

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Flat epithelial atypia of the breast commonly co-exists with atypical ductal hyperplasia, lobular neoplasia, and indolent forms of invasive carcinomas such as tubular carcinoma. Most patients with pure flat epithelial atypia on core biopsy undergo surgical excision to evaluate for carcinoma in the adjacent breast tissue. Studies to date have reported varying upgrade rates with most recommending follow-up excision. These studies have often lacked detailed radiographic correlation, central review by breast pathologists and information regarding the biology of the carcinomas identified upon excision. In this study, we report the frequency of upgrade to invasive carcinoma or ductal carcinoma in situ in excision specimens following a diagnosis of pure flat epithelial atypia on core biopsy. Radiographic correlation is performed for each case and grade/receptor status of detected carcinomas is reported. Seventy-three (73) core biopsies containing pure flat epithelial atypia were identified from our files, meeting inclusion criteria for the study. In the subsequent excision biopsies, five (7%) cases contained invasive carcinoma or ductal carcinoma in situ and seventeen (23%) contained atypical ductal hyperplasia or lobular neoplasia. All of the ductal carcinoma in situ cases with estrogen receptor results were estrogen receptor positive and intermediate grade. The invasive tumors were small (pT1a) hormone receptorpositive, HER2-negative, low-grade invasive ductal or tubular carcinomas with negative sentinel lymph-node biopsies. No upgrades were identified in the 14 patients who had all of their calcifications removed by the stereotactic core biopsy. Our rate of upgrade to carcinoma, once cases with discordant imaging are excluded, is at the lower end of the range reported in the literature. Given the low upgrade rate and indolent nature of the carcinomas associated with flat epithelial atypia, case management may be individualized based on clinical and radiographic findings. Excision may not be necessary for patients without remaining calcifications following core biopsy.

show abstract

A retrospective study of columnar alteration with prominent apical snouts and secretions and the association with cancer

Cited by 71 publications

References 6 publications

Pure flat epithelial atypia (DIN 1a) on core needle biopsy: study of 60 biopsies with follow-up surgical excision

Pure flat epithelial atypia (DIN 1a) on core needle biopsy: study of 60 biopsies with follow-up surgical excision

Digital mammography: more microcalcifications, more columnar cell lesions without atypia

Management of flat epithelial atypia on breast core biopsy may be individualized based on correlation with imaging studies

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