Isolated Flat Epithelial Atypia on Core Biopsy Specimens Is Associated With a Low Risk of Upgrade at Excision

Hugar, Sarah B; Bhargava, Rohit; Dabbs, David J.; Davis, Katie M; Zuley, Margarita L.; Clark, Beth Z.

doi:10.1093/ajcp/aqy175

Cited by 15 publications

(3 citation statements)

References 13 publications

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“…Lamb et al 10 accrued 208 CNBs with pure FEA over a nine-year period and observed an upgrade rate to carcinoma of 2.4% but they reported finding a higher risk lesion in 29.8% of cases (ADH 18.3%, LCIS 4.8%, ALH 6.7%). While Hugar et al 11 identified only one upgrade to carcinoma out of 111 CNBs with FEA they observed a higher risk lesion in 36% of cases (ADH 18%, ALH/LCIS 18%). Both studies concluded that the rate of upgrade to carcinoma is low, but surveillance is warranted along with consideration of chemoprevention for risk reduction.…”

Section: Discussionmentioning

confidence: 91%

“…Most series analyzing the upgrade rate at excision of FEA are relatively small, with only a few studies having over 100 cases. 2,[9][10][11] Furthermore, some published series 9 did not specify whether radiologic-pathologic concordance of the CNB cases was assessed or did not include dedicated re-review of histologic findings. 2,10 A recent systematic review of "16 higher-quality studies" found an estimated risk of upgrade to carcinoma of 7.5% and an estimated risk of upgrade to ADH of 18.6%.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 91%

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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“…The reported incidence of pure FEA diagnosed on CNB varies from <1–22% [ 9 , 98 ]. Similarly, the reported rate of upgrade to malignancy ranges from 0% to 38% [ 8 , 9 , 10 , 32 , 38 , 39 , 40 , 41 , 42 , 43 , 46 , 49 , 51 , 67 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 ]. Some studies have suggested criteria for excision, including assessment of radiologic features (i.e., mass versus calcifications) [ 50 ], span of calcifications [ 38 ] residual calcifications post CNB [ 103 , 111 , 117 ], and considerat...…”

Section: Clinical Significancementioning

confidence: 99%

Are Columnar Cell Lesions the Earliest Non-Obligate Precursor in the Low-Grade Breast Neoplasia Pathway?

Strickland

Turashvili

2022

Current Oncology

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Columnar cell lesions (CCLs) of the breast comprise a spectrum of morphologic alterations of the terminal duct lobular unit involving variably dilated and enlarged acini lined by columnar epithelial cells. The World Health Organization currently classifies CCLs without atypia as columnar cell change (CCC) and columnar cell hyperplasia (CCH), whereas flat epithelial atypia (FEA) is a unifying term encompassing both CCC and CCH with cytologic atypia. CCLs have been increasingly recognized in stereotactic core needle biopsies (CNBs) performed for the assessment of calcifications. CCLs are believed to represent the earliest non-obligate precursor of low-grade invasive breast carcinomas as they share molecular alterations and often coexist with entities in the low-grade breast neoplasia pathway. Despite this association, however, the risk of progression of CCLs to invasive breast carcinoma appears low and may not exceed that of concurrent proliferative lesions. As the reported upgrade rates of pure CCL/FEA when identified as the most advanced high-risk lesion on CNB vary widely, the management of FEA diagnosed on CNB remains controversial. This review will include a historical overview of CCLs and will examine histologic diagnostic criteria, molecular alterations, prognosis and issues related to upgrade rates and clinical management.

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Concepts in Breast Surgery

Sugg

Scott‐Conner

2022

Chassin's Operative Strategy in General Surgery

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Isolated Flat Epithelial Atypia on Core Biopsy Specimens Is Associated With a Low Risk of Upgrade at Excision

Cited by 15 publications

References 13 publications

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

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

Are Columnar Cell Lesions the Earliest Non-Obligate Precursor in the Low-Grade Breast Neoplasia Pathway?

Concepts in Breast Surgery

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