Flat epithelial atypia: conservative management of patients without residual microcalcifications post-vacuum-assisted breast biopsy

Schiaffino, Simone; Gristina, Licia; Villa, Alessandro; Tosto, Simona; Monetti, Francesco; Carli, Franca; Calabrese, Massimo

doi:10.1259/bjr.20170484

Cited by 15 publications

(10 citation statements)

References 33 publications

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“…The incidence of pure FEA is approximately 1-2% of benign breast biopsies [20]. It is frequently discovered secondary to suspicious microcalcifications [60]. In addition, FEA is often found in association with other high-risk lesions of the breast, such as ALH, ADH, or LN, although currently it is increasingly referred to as a precursor of the latter alteration [61] and also considered, together with ADH and DCIS, as a non-obligatory precursor of invasive carcinoma [62,63].…”

Section: Flat Atypical Epitheliamentioning

confidence: 99%

High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

et al. 2021

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Breast lesions with uncertain malignant behavior, also known as high-risk or B3 lesions, are composed of a variety of pathologies with differing risks of associated malignancy. While open excision was previously preferred to manage all high-risk lesions, tailored management has been increasingly favored to reduce overtreatment and spare patients from unnecessary anxiety or high healthcare costs associated with surgical excision. The purpose of this work is to provide the reader with an accurate overview focused on the main high-risk lesions of the breast: atypical intraductal epithelial proliferation (atypical ductal hyperplasia), lobular neoplasia (including the subcategories lobular carcinoma in situ and atypical lobular hyperplasia), flat epithelial atypia, radial scar and papillary lesions, and phyllodes tumor. Beyond merely presenting the radiological aspects of these lesions and the recent literature, information about their potential upgrade rates is discussed in order to provide a useful guide for appropriate clinical management while avoiding the risks of unnecessary surgical intervention (overtreatment).

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Section: Flat Atypical Epitheliamentioning

confidence: 99%

High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

et al. 2021

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“…These strategies include a second-opinion assessment of biopsy specimens [ 57 ] (as implemented in our center for borderline cases) or the application of artificial intelligence for upgrade prediction [ 47 ] and could gain widespread application in the future. Another less invasive but still viable approach, particularly in light of recent results, could be the careful integration of VAE with surveillance, provided that the radiologic–pathological correlation is performed and that the removed tissue shows a low presence of atypical cytological features [ 16 , 24 , 25 , 26 , 27 , 28 ]. Of note, however, the need for personalized imaging surveillance (not limited to biennial mammography but potentially including supplemental ultrasound, digital breast tomosynthesis, contrast-enhanced MRI, and contrast-enhanced mammography) could be postulated for all patients with B3 lesions, also after surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The key issue is that the management of these lesions is highly controversial and is therefore the center of a lively debate, that could be fittingly approached by building evidence from large series, which are still sporadically available [ 14 , 15 , 16 ]. If performed with large-caliber needles, VAB seems to consistently improve lesion characterization in B3 lesions [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ], even assuming a therapeutic role with vacuum-assisted excision, which is increasingly being proposed with interesting results [ 25 , 26 , 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

B3 Lesions at Vacuum-Assisted Breast Biopsy under Ultrasound or Mammography Guidance: A Single-Center Experience on 3634 Consecutive Biopsies

Girardi

Guaragni

Ruzzenenti

et al. 2021

Cancers

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The rate of upgrade to cancer for breast lesions with uncertain malignant potential (B3 lesions) diagnosed at needle biopsy is highly influenced by several factors, but large series are seldom available. We retrospectively assessed the upgrade rates of a consecutive series of B3 lesions diagnosed at ultrasound- or mammography-guided vacuum-assisted biopsy (VAB) at an EUSOMA-certified Breast Unit over a 7-year timeframe. The upgrade rate was defined as the number of ductal carcinoma in situ (DCIS) or invasive cancer at pathology after excision or during follow-up divided by the total number of B3 lesions. All lesions were reviewed by one of four pathologists with a second opinion for discordant assessments of borderline cases. Excision or surveillance were defined by the multidisciplinary tumor board, with 6- and 12-month follow-up. Out of 3634 VABs (63% ultrasound-guided), 604 (17%) yielded a B3 lesion. After excision, 17/604 B3 lesions were finally upgraded to malignancy (2.8%, 95% confidence interval [CI] 1.8–4.5%), 10/17 (59%) being upgraded to DCIS and 7/17 (41%) to invasive carcinoma. No cases were upgraded during follow-up. B3a lesions showed a significantly lower upgrade rate (0.4%, 95% CI 0.1–2.1%) than B3b lesions (4.7%, 95% CI 2.9–7.5%, p = 0.001), that had a 22.0 adjusted odds ratio for upgrade (95% CI 2.1–232.3). No significant difference was found in upgrade rates according to imaging guidance or needle caliper. Surveillance-oriented management can be considered for B3a lesions, while surgical excision should be pursued for B3b lesions.

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“…The sonographic features of FEA are even more ambiguous, and may resemble those associated with DCIS or ADH, including irregular masses with microlobulated borders. 18 Schiaffino et al 19 examined the upgrade rate following conservative (non-surgical) management of patients who had a biopsy with FEA which targeted a single group of calcifications, completely removed on biopsy. Only cases with pure FEA without any other atypia and in patients with no prior or concurrent history of carcinoma were included.…”

Section: Discussionmentioning

confidence: 99%

Flat Epithelial Atypia in Breast Core Needle Biopsies With Radiologic-Pathologic Concordance

Grabenstetter¹,

Brennan²,

Salagean³

et al. 2019

American Journal of Surgical Pathology

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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 1/2012-7/2018 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 re-reviewed. 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 re-review, we reclassified 14 cases (2 marked nuclear atypia, 10 focal ADH, 2 benign). The final FEA study cohort consisted of 40 CNBs from 40 women. The CNB targeted mammographic calcifications in 36 (90%) cases, MRI non-mass enhancement in 3 (8%), and 1 (2%) sonographic mass. All CNBs were deemed radiologicpathologic concordant. FEA was present alone in 34 CNBs and with LN in 6. EXC yielded 2 low grade IC, each spanning less than 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 non-surgical management may be considered in patients without prior/concurrent carcinoma and radiologicpathologic concordant CNB diagnosis of FEA.

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Flat epithelial atypia: conservative management of patients without residual microcalcifications post-vacuum-assisted breast biopsy

Cited by 15 publications

References 33 publications

High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

B3 Lesions at Vacuum-Assisted Breast Biopsy under Ultrasound or Mammography Guidance: A Single-Center Experience on 3634 Consecutive Biopsies

Flat Epithelial Atypia in Breast Core Needle Biopsies With Radiologic-Pathologic Concordance

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