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.
|Mammographic Findings||No. of cases||Diagnosis on Follow Up Surgery|
|Calcifications Only||5||IDC (1)|
|Calcifications and mass||2||Benign (1) + fibroadenoma|
|FEA (1) + cyst|
|Asymmetric Enhancement||1||FEA (1)|