Flat epithelial atypia (DIN 1a, atypical columnar change): an underdiagnosed entity very frequently coexisting with lobular neoplasia

Leibl, Sebastian; Regitnig, Peter; Moinfar, Farid

doi:10.1111/j.1365-2559.2007.02700.x

Cited by 55 publications

(36 citation statements)

References 26 publications

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“…The prevalence of atypical ductal hyperplasia associated with columnar cell lesions in vacuum-assisted core biopsies in the present series is quite low, but on the final surgical specimens, we confirmed that atypical ductal hyperplasia and lobular intraepithelial neoplasia were the most common accompanying lesions. [20][21][22] In addition, our results show that small papillomas/papillomatosis of terminal duct lobular unit are often related to columnar cell lesions as well. In a recent study on a small series of core biopsies not-vacuum-assisted, 23 it has been shown that flat epithelial atypia was associated with malignancy in 2 out of 11 cases.…”

Section: Discussionsupporting

confidence: 54%

“…10 Because estrogen stimulates proliferation 24 and suppresses apoptosis 25 in normal cells, elevated estrogen receptor expression in columnar cell lesions may be a fundamental alteration leading to hyperplasia that occasionally progresses to atypia and cancer. 26 In Correlations of columnar cell lesions on VACB R Senetta et al fact, columnar cell lesions are considered not obligate precursors of lobular and tubular carcinomas, 12,[20][21][22] two cancer histotypes closely related to hormone replacement therapy exposure. 27 Interestingly, the results of a recent experimental study indicate that 17b-estradiol exposure of postmenopausal primates promotes proliferation of flat epithelial atypia.…”

Section: Discussionmentioning

confidence: 99%

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Columnar cell lesions associated with breast calcifications on vacuum-assisted core biopsies: clinical, radiographic, and histological correlations

et al. 2009

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Columnar cell lesions of the breast are increasingly recognized at mammography for their tendency to calcify. We studied 392 vacuum-assisted core biopsies performed solely for calcifications to evaluate the frequency of columnar cell lesions, their relationship with radiological risk, appearance of calcifications, and clinical data. Management and follow-up of columnar cell lesions without and with atypia (flat epithelial atypia) was analyzed. Cases with architectural atypia (cribriform spaces and/or micropapillae) were excluded from flat epithelial atypia. Calcifications were within the lumen of acini affected by columnar cell lesions in 137 out of 156 biopsies diagnosed with some columnar cell lesions. These represented 37% of vacuum-assisted core biopsies and 62% of low radiological risk (BI-RADS3) calcifications. High-risk (BI-RADS5) calcifications were never associated with columnar cell lesions. Age and menopausal status were comparable in columnar and in not-columnar cell lesions. Atypia was associated with long-term hormone replacement therapy in both lesions. Surgical biopsy was recommended for all cases with atypia. Flat epithelial atypia, as the only histological findings on vacuum-assisted core biopsies, was never associated with malignancy at surgery. In conclusion, we suggest that surgical excision is not mandatory when flat epithelial atypia is found as the most advanced lesion on vacuum-assisted core biopsy performed for low radiological risk calcifications, and that women should be advised of the possible hormone dependency of this entity. Modern Pathology ( Keywords: columnar cell lesions; flat epithelial lesion; calcifications Stereotactic vacuum-assisted core biopsy is currently used to diagnose indeterminate or suspicious breast calcifications that are histologically related to a spectrum of breast lesions encompassing ductal carcinomas in situ and preneoplastic and benign lesions. Often this type of calcification resides in so-called 'columnar cell lesions', 1 entities characterized by the presence of columnar epithelial cells lining the terminal duct lobular units that typically show flocculant or secretory material and microcalcifications in the lumen. The Breast Imaging Reporting and Data System (BI-RADS) 2 has standardized the description and management of findings identified on mammograms, thereby facilitating communication between radiologists and referring physicians. However, to our knowledge, there are no specific studies evaluating whether specific calcification descriptors are associate with columnar cell lesions.Columnar cell lesions have been described under a variety of names. [3][4][5][6][7] According to Schnitt and Vincent-Salomon, 1 columnar cell lesions have been grouped into the categories of columnar cell change and columnar cell hyperplasia without or with atypia. Other authors 8 have proposed a subcategorization of columnar cell lesions depending on the presence of architectural and/or cytological atypia. The unifying term 'flat epithelial atypia' has been proposed by ...

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Columnar cell lesions associated with breast calcifications on vacuum-assisted core biopsies: clinical, radiographic, and histological correlations

et al. 2009

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“…Although the biological and clinical significance of FEA is still far from completely understood, emerging histological and molecular evidence suggests that FEA may represent the earliest morphologically identifiable non-obligatory precursor of low-grade breast cancer 5,6 . In fact, FEA often coexists with more advanced atypical proliferative breast lesions such as ADH and atypical lobular hyperplasia (LIN1/ALH) or low-grade ductal carcinoma in situ (DCIS, particularly micropapillary and cribriform type), lobular carcinoma in situ (LIN2/LCIS), tubular carcinoma and invasive lobular carcinoma (ILC) [7][8][9][10][11][12]. Otherwise, the possibility that columnar cell lesions in general and FEA in particular significantly elevate breast cancer risk is at the moment not well supported 13,14 .…”

Section: Introductionmentioning

confidence: 99%

Morphological parameters of flat epithelial atypia (FEA) in stereotactic vacuum-assisted needle core biopsies do not predict the presence of malignancy on subsequent surgical excision

et al. 2012

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Flat epithelial atypia (FEA) may represent the earliest precursor of low-grade breast cancer and often coexists with more advanced atypical proliferative breast lesions such as atypical ductal hyperplasia (ADH) and lobular intraepithelial neoplasia (LIN). The present study aims to investigate the association between morphological parameters of FEA and presence of malignancy at surgical excision (SE) and the clinical significance of the association of FEA stereotactic 11-gauge vacuum-assisted needle core biopsy (VANCB), reporting a diagnosis of FEA, ADH or LIN with subsequent SE from 14 pathology departments in Italy. Available slides were reviewed, with 114 (19.4 %) showing a malignant outcome at SE. Among the 190 cases of pure FEA, no statistically significant association emerged between clinical-pathological parameters of FEA and risk of malignancy. Logistic regression analyses showed an increased risk of malignancy according to the extension of ADH among the 275 cases of FEA associated with ADH (p00.004) and among the 34 cases of FEA associated with ADH and LIN (p00.02). In the whole series, a statistically significant increased malignancy risk emerged according to mammographic R1-R3/R4-R5 categories (OR01.56; p0 0.04), extension (OR01.24; p00.04) and grade (OR01.94; p00.004) of cytological atypia of FEA. The presence of ADH was associated with an increased malignancy risk (OR02.85; p<0.0001). Our data confirm the frequent association of FEA with ADH and/or LIN. A diagnosis of pure FEA on VANCB carries a 9.5 % risk of concurrent malignancy and thus warrants follow-up excision because none of the clinical-pathological parameters predicts which cases will present carcinoma on SE.

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“…Die Inzidenz der FEA in Biospien beträgt 2,7-3,6% [12,16]. Nach Untersuchungen an Segmentexzidaten wird Multifokalität der FEA in 61-75% beschrieben [12,16].…”

Section: Inzidenz Und Multifokalitätunclassified

“…Charakteristisch kann man die Assoziation der FEA mit LN nennen; sie wird in 53-87% gefunden [16]. [20].…”

Section: Assoziation Mit Anderen Atypischen Proliferationen Und Prognoseunclassified

Praktische Probleme im Mammographie-Screening

Nährig

2008

Pathologe

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Flat epithelial atypia (DIN 1a, atypical columnar change): an underdiagnosed entity very frequently coexisting with lobular neoplasia

Cited by 55 publications

References 26 publications

Columnar cell lesions associated with breast calcifications on vacuum-assisted core biopsies: clinical, radiographic, and histological correlations

Columnar cell lesions associated with breast calcifications on vacuum-assisted core biopsies: clinical, radiographic, and histological correlations

Morphological parameters of flat epithelial atypia (FEA) in stereotactic vacuum-assisted needle core biopsies do not predict the presence of malignancy on subsequent surgical excision

Praktische Probleme im Mammographie-Screening

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