J Cancer 2016; 7(1):1-6. doi:10.7150/jca.12781
Analysis of Clinical and Pathologic Factors of Pure, Flat Epithelial Atypia on Core Needle Biopsy to Aid in the Decision of Excision or Observation
1. Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX;
2. Department of Surgery, Madigan Military Medical Center, Fort Lewis, WA;
3. Department of Surgical Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, TX;
4. Qwest Care Associates, Intensive Care Unit, Metropolitan Methodist Hospital, San Antonio, TX;
5. Department of Radiology, San Antonio Military Medical Center, Fort Sam Houston, TX;
6. Department of Pathology, San Antonio Military Medical Center, Fort Sam Houston, TX;
7. Director, Cancer Vaccine Development Program, San Antonio, TX, USA.
Berry JS, Trappey AF, Vreeland TJ, Pattyn AR, Clifton GT, Berry EA, Schneble EJ, Kirkpatrick AD, Saenger JS, Peoples GE. Analysis of Clinical and Pathologic Factors of Pure, Flat Epithelial Atypia on Core Needle Biopsy to Aid in the Decision of Excision or Observation. J Cancer 2016; 7(1):1-6. doi:10.7150/jca.12781. Available from http://www.jcancer.org/v07p0001.htm
Background: The optimal treatment of flat epithelial atypia (FEA) found on breast core needle biopsy (CNB) is controversial. We performed a retrospective review of our institutional experience with FEA to determine if excisional biopsy may be deferred.
Methods: Surgical records from 2009 to 2012 were reviewed for FEA diagnosis. After exclusion for concomitant lesions, CNBs of pure FEA were classified using a previously agreed upon descriptor of “focal” versus “prominent”. Data was analyzed with the Fisher's Exact and Student-t test as appropriate.
Results: Of 71 CNBs evaluated, pure FEA was identified on 27 CNBs. Final excisional biopsy was benign in 24 of 27 cases (88%) with associated ductal carcinoma in-situ (DCIS) in 3 of 27 cases (11%). Eighteen of 27 (67%) CNBs were classified as focal while 9 (33%) were described as prominent. Zero of the 18 focal patients had a malignancy compared to 3 of the 9 in the prominent group (0% vs 33%, p=0.02). Of the 27 pure FEA CNBs, 6 patients had a personal history of breast carcinoma, five DCIS and one invasive ductal carcinoma. No malignancies were found in the 21 patients without a personal history of breast carcinoma versus three in the patients with a positive history (0/21 v 3/6, p=0.007).
Conclusions: Our data suggests those women who have adequate sampling and sectioning of CNBs, with focal, pure FEA on pathology, and are without a personal history of breast cancer may undergo a period of imaging surveillance. Conversely, patients with a history of breast cancer or pure, prominent FEA on CNB disease should proceed to excisional biopsy.
Keywords: Pure Flat Epithelial Atypia, Ductal Intraepithelial Neoplasia, Pure FEA, DIN 1A, Columnar Cell Change with atypia, Columnar Cell Hyperplasia with Atypia.