| Abstract: |
Background: Flat epithelial atypia (FEA), a rare breast proliferative lesion, is often diagnosed following core biopsy (CB) of mammographic microcalcifications. In the prospective multi-institution TBCRC 034 trial, we investigate the upgrade rate to ductal carcinoma in situ (DCIS) or invasive cancer following excision for patients diagnosed with FEA on CB. Patients and Methods: Patients with a breast imaging reporting and data system (BI-RADS) ≤ 4 imaging abnormality and a concordant CB diagnosis of FEA were identified for excision. Upgrade rates were determined on the basis of local and central pathology review. The prespecified threshold to omit excision of FEA on CB was an upgrade rate of ≤ 3%. Sample size and confidence intervals were based on exact binomial calculation. Results: Overall, 129 patients underwent excision (median age 50 years, range 30–84 years). After local pathology review, 6/129 patients (4.7%; 95% CI 1.7–9.8%) were upgraded to invasive carcinoma (n = 3) or DCIS (n = 3) at excision. Among 116 patients with CB available for central pathology review, FEA was confirmed in 78 (67.2%, 95% CI 57.9–75.7%). Of these, only one patient was upgraded to DCIS (1.3%; 95% CI 0.03–6.9%), which was also one of the locally upgraded cases. Among the other five local upgrades, two did not have CB available for central review, two CB had ADH, and one CB had normal tissue on central review. Conclusions: Among patients with FEA on CB, the upgrade rate was 4.7% based on local pathology review and 1.3% based on central pathology review. These findings highlight the importance of shared decision-making in the management of FEA. © Society of Surgical Oncology 2024. |
| Keywords: |
adult; controlled study; human tissue; aged; aged, 80 and over; middle aged; excision; major clinical study; clinical trial; histopathology; nuclear magnetic resonance imaging; follow up; follow-up studies; cancer incidence; prospective study; prospective studies; incidence; pathology; diagnostic imaging; breast neoplasms; mammography; multicenter study; breast tumor; needle biopsy; surgery; neoplasm invasiveness; neoplasms, multiple primary; carcinoma, intraductal, noninfiltrating; breast lesion; ductal carcinoma in situ; sample size; lobular carcinoma in situ; carcinoma, ductal, breast; core biopsy; atypical ductal hyperplasia; tumor invasion; flat epithelial atypia; upgrade rate; biopsy, large-core needle; large core needle biopsy; very elderly; breast imaging reporting and data system; invasive breast cancer; humans; prognosis; human; female; article; breast ductal carcinoma; ductal breast carcinoma in situ; invasive ductal breast carcinoma; multiple primary neoplasm
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