Pure flat epithelial atypia: Is there a place for routine surgery?

Ceugnart, L.; Doualliez, V.; Chauvet, Marie Pierre; Robin, Y.; Bachelle, F.; Chaveron, C.; Rocourt, N.; Pouliquen, G.; Jarraya, H.; Taïeb, S.

doi:10.1016/j.diii.2013.01.011

Cited by 30 publications

(18 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An issue in the current clinical management of FEA is the question of surgical excision when FEA is diagnosed with core needle biopsy. Although outside the scope of the current investigation, other retrospective studies have reported that cancer is found in approximately 3% to 13% of women with FEA on core needle biopsy who subsequently undergo surgical excision . This finding is not surprising, given the association between FEA and AH that we observed, and the known risk of an upgrade to cancer with surgical excision of AH.…”

Section: Discussionsupporting

confidence: 57%

“…This finding is not surprising, given the association between FEA and AH that we observed, and the known risk of an upgrade to cancer with surgical excision of AH. In addition to a small risk of detecting cancer at the time of surgical excision, multiple studies have reported finding other high‐risk lesions (AH or lobular carcinoma in situ) in 20% to 52% of women undergoing excision of FEA found at core needle biopsy . Although the majority of studies recommend surgical excision for FEA detected on core needle biopsy, others have suggested that this might not be warranted.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Said

Visscher

Nassar

et al. 2015

Cancer

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

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

Said

Visscher

Nassar

et al. 2015

Cancer

View full text Add to dashboard Cite

show abstract

“…Management recommendations in corporate the actual risk of progression, which is low. Open biopsy must be considered when suspicious microcalcifica tions or a mass lesion remain radiologically detectable after core needle or vacuumassisted biopsy [37].…”

Section: Prognostic and Predictive Factorsmentioning

confidence: 99%

AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2016

Liedtke

Thill

2016

Breast Care

View full text Add to dashboard Cite

show abstract

“…7–12 Nevertheless, a diagnosis of FEA includes the word “atypia” in its name, potentially causing concern to patients and clinicians. FEA has been associated with and may coexist with a family of indolent risk-associated proliferative lesions including atypical lobular hyperplasia (ALH), atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS), low-grade ductal carcinoma in situ (DCIS), and, less frequently, low-grade invasive carcinoma.…”

Section: Introductionmentioning

confidence: 99%

Surgical implications and variability in the use of the flat epithelial atypia diagnosis on breast biopsy specimens

et al. 2017

View full text Add to dashboard Cite

Objectives Flat epithelial atypia (FEA) is a relatively new diagnostic term with uncertain clinical significance for surgical management. Any implied risk of invasive breast cancer associated with FEA is contingent upon diagnostic reproducibility, yet little is known regarding its use. Materials and Methods Pathologists in the Breast Pathology Study interpreted one of four 60-case test sets, one slide per case, constructed from 240 breast biopsy specimens. An electronic data form with standardized diagnostic categories was used; participants were instructed to indicate all diagnoses present. We assessed participants’ use of FEA as a diagnostic term within: 1) each test set; 2) 72 cases classified by reference as benign without FEA; and 3) six cases classified by reference as FEA. 115 pathologists participated, providing 6,900 total independent assessments. Results Notation of FEA ranged from 0% to 35% of the cases interpreted, with most pathologists noting FEA on 4 or more test cases. At least one participant noted FEA in 34 of the 72 benign non-FEA cases. For the 6 reference FEA cases, participant agreement with the case reference FEA diagnosis ranged from 17% to 52%; diagnoses noted by participating pathologists for these FEA cases included columnar cell hyperplasia, usual ductal hyperplasia, atypical lobular hyperplasia, and atypical ductal hyperplasia. Conclusions We observed wide variation in the diagnosis of FEA among U.S. pathologists. This suggests that perceptions of diagnostic criteria and any implied risk associated with FEA may also vary. Surgical excision following a core biopsy diagnosis of FEA should be reconsidered and studied further.

show abstract

Pure flat epithelial atypia: Is there a place for routine surgery?

Cited by 30 publications

References 31 publications

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

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

AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2016

Surgical implications and variability in the use of the flat epithelial atypia diagnosis on breast biopsy specimens

Contact Info

Product

Resources

About