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

Lavoué, Vincent; Roger, Claire Marie; Poilblanc, Mathieu; Proust, Nicolas; Monghal-Verge, Camille; Sagan, Christine; Tas, Patrick; Mesbah, H.; Porée, Philippe; Body, G.; Lévèque, Jean

doi:10.1007/s10549-010-1208-1

Cited by 60 publications

(37 citation statements)

References 22 publications

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“…Recently, Abdel-Fatah et al 8 found that columnar cell lesions, predominantly FEA, and LIN coexist in 60 % of cases of ILC, suggesting that the loss of E-cadherin expression may switch on the development of lobular differentiation, and proposed an evolutionary pathway f ILC through columnar cell lesions on the basis of histological evidence and common genetic changes. We found FEA associated with LIN in 15.3 % (90/589) of cases, in agreement with data reported by Levoue et al 27 , which results in a malignancy underestimation rate of 14.4 %.…”

Section: Discussionsupporting

confidence: 93%

“…The identification of FEA also poses a diagnostic challenge to the pathologist, particularly in CB, because FEA with mild cytological atypia may be subtle and care should be taken not to overlook the lesion or to over-diagnose it and reporting as atypical any columnar cell lesion 17,18 . Our results confirm previous reports 11,[25][26][27] that almost all patients (185/190, 97.4 %) with pure FEA are asymptomatic and that microcalcifications are the main determinant in 91 % (173/190) of cases. As earlier studies reported 11 , we found moderate to severe chronic inflammation in 12 % of pure FEA cases (23/190) and stromal changes, including myxoid change and fibrosis in 36.3 % (69/190), of which the significance remains to be clarified.…”

Section: Discussionsupporting

confidence: 92%

“…The preoperative histological diagnosis of FEA poses a management dilemma for the clinician. Although there is no definitive agreement at present on the clinical management of FEA (underestimation rates for CB diagnosis of pure FEA reported in the literature vary from 0 to 67 % 13 ), the currently prevailing recommendation is that it warrants follow-up surgical excision 1,27 . A few studies in the published literature support the follow-up observation for the management of pure FEA 26,28,29 .…”

Section: Discussionmentioning

confidence: 99%

“…As earlier studies reported 11 , we found moderate to severe chronic inflammation in 12 % of pure FEA cases (23/190) and stromal changes, including myxoid change and fibrosis in 36.3 % (69/190), of which the significance remains to be clarified. 11,12,26,27,30 . The association of FEA with ADH has an important impact on clinical management as for ADH on CB the need for surgical excision is unanimously recognized 31 .…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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“…In some series, the upgrade rate of FEA is as high as 10% (37). Lavoué et al (38) indicate that the presence of FEA on core needle biopsy, even in isolation, warrants follow-up excision. However, some recent studies report that women with FEA without residual microcalcifications after VABB can be conservatively managed.…”

Section: Discussionmentioning

confidence: 99%

Vacuum-assisted stereotactic breast biopsy in the diagnosis and management of suspicious microcalcifications

Esen

Tutar²,

Uras³

et al. 2016

Diagn Interv Radiol

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C urrently, the gold standard for breast biopsies is open excision of the suspected lesion. However, an excisional biopsy inevitably leaves a scar behind. The cost and morbidity associated with this procedure have prompted many physicians to evaluate less invasive and alternative procedures (1-3).Clustered suspicious microcalcifications can be a very early sign of malignancy, particularly typical for ductal carcinoma in situ (DCIS). Microcalcifications are usually detected on screening mammographies, and most of them cannot be identified on ultrasonography (US). Lesions detected only on mammography require stereotactic guidance for biopsy, and vacuum-assisted breast biopsy (VABB) is currently the biopsy method of choice for stereotactic biopsies. VABB is considered to be a safe procedure and is comparable to surgical biopsy for the characterization of microcalcifications (4, 5). Studies have shown that it is a very accurate biopsy method and is characterized by high-quality specimens, high calcification retrieval, and low rates of false-negative results (6-10). In case of microcalcifications, complete percutaneous excision is frequently possible, which leads to a decrease in sampling error as well as a decrease in upgrade rate, imaging-pathology discordance, and re-biopsy rate. The likelihood of subsequent growth on follow-up is also diminished. VABB is not a therapeutic procedure for malignant lesions; however, using VABB for diagnosis rather than surgical biopsy decreases the number of operations required (11-13).Vacuum biopsy can be used for the histopathologic diagnosis of all nonpalpable breast lesions; however, it is mostly reserved for mammographically detected lesions, mainly mi- BREAST IMAGING O R I G I N A L A R T I C L E PURPOSEWe aimed to present our biopsy method and retrospectively evaluate the results, upgrade rate, and follow-up findings of stereotactic vacuum-assisted breast biopsy (VABB) procedures performed in our clinic. METHODSTwo hundred thirty-four patients with mammographically detected nonpalpable breast lesions underwent VABB using a 9 gauge biopsy probe and prone biopsy table. A total of 195 patients (median age 53 years, range 32-80 years) with 198 microcalcification-only lesions with a follow-up of at least one year were included in the study. The location of the lesion relative to the needle was determined from the postfire images, and unlike the conventional technique, tissue retrieval was predominantly performed from that location, followed by a complete 360° rotation, if needed. RESULTSThe median core number was 8.5. Biopsy results revealed 135 benign, 24 atypical, and 39 malignant lesions. The total upgrade rate at surgery was 7.7% (6.1% for ductal carcinomas in situ and 10.5% for atypical lesions). Patients with benign lesions were followed up for a median period of 27.5 months, with no interval change. At the follow-up, scar formation was seen in 23 patients (17%); three of the scars were remarkable for resembling a malignancy. CONCLUSIONOur biposy method is fast and practica...

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Flat epithelial atypia and risk of breast cancer: A Mayo cohort study

Said

Visscher

Nassar

et al. 2015

Cancer

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Background Based on its cytologic features, and its co-occurrence with atypical hyperplasia and breast cancer, flat epithelial atypia (FEA) has been proposed as a precursor lesion on the pathway to breast cancer development. It is often referred to as an “atypical” or high-risk lesion. However, the long term risk of breast cancer in women with FEA is undefined. Methods Biopsies with FEA were identified in excisional breast biopsies in the Mayo Clinic Benign Breast Disease (BBD) Cohort, which includes 11,591 women who had benign biopsies at Mayo-Rochester 1967–2001. Breast cancer risk of FEA, non-proliferative, proliferative and atypical hyperplasia (AH) subsets was assessed using standardized incidence ratios (SIRs), relative to the Iowa Surveillance, Epidemiology, and End Results registry. Results FEA was identified in 282 women (2.4%); 130 had associated AH (46%) and 152 (54%) were classified as proliferative disease without atypia (PDWA). With median follow-up of 16.8 years, the SIR for breast cancer in AH + FEA was 4.74 (95% CI: 3.17–6.81) versus 4.23 (3.44–5.13) for AH without FEA (p=0.59). The SIR for PDWA + FEA was 2.04 (95% CI: 1.23–3.19) versus 1.90 (1.72–2.09) for PDWA without FEA (p=0.76). Conclusions FEA is an uncommon finding in women with BBD. FEA does not convey independent risk of breast cancer beyond that of the associated PDWA or AH.

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

Cited by 60 publications

References 22 publications

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

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

Vacuum-assisted stereotactic breast biopsy in the diagnosis and management of suspicious microcalcifications

Flat epithelial atypia and risk of breast cancer: A Mayo cohort study

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