Flat epithelial atypia in breast core needle biopsies with radiologic-pathologic concordance: Is excision necessary? Journal Article

   

Authors:	Grabenstetter, A.; Brennan, S.; Salagean, E. D.; Morrow, M.; Brogi, E.
Article Title:	Flat epithelial atypia in breast core needle biopsies with radiologic-pathologic concordance: Is excision necessary?
Abstract:	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 January 2012 and July 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 rereviewed. 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 rereview, we reclassified 14 cases (2 marked nuclear atypia, 10 focal atypical ductal hyperplasia, 2 benign). The final FEA study cohort consisted of 40 CNBs from 40 women. The CNB targeted mammographic calcifications in 36 (90%) cases, magnetic resonance imaging nonmass enhancement in 3 (8%), and 1 (2%) sonographic mass. All CNBs were deemed radiologic-pathologic concordant. FEA was present alone in 34 CNBs and with LN in 6. EXC yielded 2 low-grade IC, each spanning <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 nonsurgical management may be considered in patients without prior/concurrent carcinoma and radiologic-pathologic concordant CNB diagnosis of FEA. © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Keywords:	invasive carcinoma; ductal carcinoma in situ; lobular carcinoma in situ; atypical ductal hyperplasia; upgrade; columnar cell change
Journal Title:	American Journal of Surgical Pathology
Volume:	44
Issue:	2
ISSN:	0147-5185
Publisher:	Lippincott Williams & Wilkins
Date Published:	2020-02-01
Start Page:	182
End Page:	190
Language:	English
DOI:	10.1097/pas.0000000000001385
PUBMED:	31609784
PROVIDER:	scopus
PMCID:	PMC6954312
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85073730655&doi=10.1097%2fPAS.0000000000001385&partnerID=40&md5=c14eb8ebb507189cc8751053a623e387
Notes:	Article -- Export Date: 2 March 2020 -- Source: Scopus

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