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[104] Clinical and Pathologic Features of Ductal Carcinoma In Situ (DCIS) Associated with the Presence of Flat Epithelial Atypia: An Analysis of 441 Cases

L Collins, S Schnitt, N Achacoso, L Nekhlyudov, S Fletcher, R Haque, L Habel. Beth Israel Deaconess Med. Ctr. and Harvard Medical School, Boston, MA; Northern California Kaiser Permanente, CA; Harvard Pilgrim Health Center, Boston, MA; Southern California Kaiser Permanente, CA

Background: Flat epithelial atypia (FEA) is an alteration of mammary terminal duct lobular units that is considered to be a precursor to or early stage in the development of some forms of DCIS. However, no prior study has systematically evaluated the relationships between clinico-pathologic features of the DCIS and the presence of co-existent FEA. A better understanding of such relationships could provide further insights into the connection between FEA and DCIS.
Design: We performed a detailed slide review in 441 DCIS patients as part of a larger case-control study assessing epidemiologic and pathologic risk factors for local recurrence in women with DCIS treated with breast-conserving therapy. We examined the association between the presence of FEA in these specimens and various clinical factors (age at diagnosis, presentation, family history), pathologic features of DCIS (nuclear grade, architectural pattern, comedo necrosis, cancerization of lobules, stromal desmoplasia, stromal inflammation) and the presence of atypical ductal hyperplasia (ADH), lobular neoplasia (LN), and non-atypical columnar cell lesions (CCL).
Results: FEA was present in 71 (16%) of the 441 specimens with DCIS. The presence of FEA was not significantly associated with age at diagnosis, presentation, or family history of breast cancer. In univariate analysis, pathologic features of DCIS significantly associated with the presence of FEA were low nuclear grade (p<0.001), micropapillary pattern (p<0.001), absence of comedo necrosis (p<0.001), absence of stromal desmoplasia (p=0.01) and absence of stromal inflammation (p=0.01). In multivariable analysis, the features of DCIS independently associated with FEA were micropapillary pattern (p=0.02) and absence of comedo necrosis (p<0.01). In addition, FEA was significantly associated with the presence of ADH, LN, and CCL in these specimens in both univariate and multivariable analyses.
Conclusions: FEA is more often seen in association with DCIS lesions with particular pathologic features, such as low nuclear grade, absence of comedo necrosis and micropapillary pattern. These observations provide support for a precursor-product relationship between FEA and DCIS lesions that exhibit such features.
Category: Breast

Monday, March 26, 2007 11:00 AM

Platform Session: Section D, Monday Morning