[152] Is Breast Excision Necessary When Flat Epithelial Atypia Is Diagnosed on Breast Core Biopsy?

Arline Faustin, Chandrakanth Annaiah, Shikha Bose, Farnaz Dadmanesh. Cedars Sinai Medical Center, Los Angeles, CA

Background: Flat epithelial atypia (FEA) is a preneoplastic condition that is associated with low-grade ductal carcinoma in situ (DCIS), invasive tubular carcinoma, and lobular neoplasia. FEA is characterized by the replacement of normal luminal epithelial cells with atypical cuboidal to tall columnar cells arranged in a single or stratified layer. Although genetic studies have shown similarities to low grade DCIS, follow-up studies have shown low rates of progression. An increased incidence of FEA is being encountered on needle core biopsies due to its frequent association with calcifications on mammography.This causes a dilemma in management of patients, raising questions of whether these lesions need complete excision. This study was therefore conducted to determine the necessity of complete excision following a needle core biopsy.
Design: Thirty-three cases of pure FEA on needle core biopsy were retrieved from departmental files from 2005 to 2010. Of the thirty-three cases, 11 (33%) underwent subsequent excision. These women ranged in age from 45-69 years of age. H&E slides were reviewed to confirm diagnosis.
Results: Details of initial mammographic findings and diagnoses on follow-up surgeries are provided in Table 1. Subsequent excision detected infiltrating carcinoma in 2 (18%) cases of pure FEA.

Table 1. Mammography and Subsequent Findings on Excision

Mammographic Findings	No. of cases	Diagnosis on Follow Up Surgery
Calcifications Only	5	IDC (1)
		ADH (2)
		UDH (2)
Calcifications and mass	2	Benign (1) + fibroadenoma
		FEA (1) + cyst
Asymmetric Enhancement	1	FEA (1)
N/A	3	ITC (1)
		FEA (2)

FEA Flat epithelial atypia; ADH atypical ductal hyperplasia; UDH usual ductal hyperplasia; IDC infiltrating ductal carcinoma in situ; ITC infiltrating tubular carcinoma; G Grade; N/A mammography performed at outside facility


Conclusions: Needle core biopsies with pure FEA showed malignancy in a significant number of cases on subsequent excision. Additional studies are needed to validate excisional biopsies as standard management for FEA. In the event that an excision is not performed active surveillance of these lesions is necessary for early detection of any cancers.
Category: Breast

Monday, February 28, 2011 1:00 PM

Poster Session II # 37, Monday Afternoon