Flat Epithelial Atypia and Atypical Ductal Hyperplasia: Carcinoma Underestimation Rate

Ingegnoli, Anna; D'Aloia, Cecilia; Frattaruolo, Antonia; Pallavera, Lara; Martella, Eugenia; Crisi, Girolamo; Zompatori, Maurizio

doi:10.1111/j.1524-4741.2009.00850.x

Cited by 61 publications

(29 citation statements)

References 35 publications

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“…These authors also noted that tumors excised after NCB diagnosis of pure FEA had favorable prognostic factors. 22 Moreover, Ingegnoli et al 23 have reported similar results where 20% of pure FEA were malignant (3/15).…”

supporting

confidence: 59%

Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Rakha

Lee

Jenkins

et al. 2011

Intl Journal of Cancer

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In the setting of breast cancer screening, 5-9% of needle core biopsies are diagnosed as lesions of uncertain malignant potential (B3). The management of these lesions is potentially problematic as the data on their outcome remains limited. In our study, we aim to assess the outcome of screen-detected lesions diagnosed as B3 in a large series to validate previous studies and to characterize the malignant lesions detected after a B3 diagnosis. Therefore, the results of 1,025 needle core biopsies of women screened over a 7-year period (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006) in two different regions in the UK with B3 diagnoses who underwent surgical excision were reviewed and compared to the final excision histology. Final histology showed that 25% of cases were malignant (17% ductal carcinoma in situ and 8% invasive). Predictors of malignancy included calcification on imaging and epithelial atypia on needle core biopsy particularly atypical ductal hyperplasia [positive predictive value 50%]. Pure flat epithelial atypia showed the lowest positive predictive value amongst all epithelial atypia groups (21%). The positive predictive value was low for complex sclerosing lesions (9%) and papillary lesions (13%) without epithelial atypia. Malignant tumors detected after B3 diagnosis showed favorable histological features, the majority were in situ, and most belonged to the low grade breast neoplasia family that is associated with indolent behavior. The underlying radiological abnormality was calcification in 44% of cases and the imaging classification was malignant/suspicious in 38%. In conclusion, our results further emphasize the heterogeneity of B3 lesions and that the likelihood of malignancy varies substantially between different histological subtypes. Malignancy is particularly associated with epithelial atypia suggesting the use of two categories of with and without epithelial atypia. Radiological findings provided useful information regarding the nature and outcome of B3 lesions.

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supporting

confidence: 59%

Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Rakha

Lee

Jenkins

et al. 2011

Intl Journal of Cancer

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“…When considering the stereotactically guided biopsies in our sample, the frequency of pure flat epithelial atypia increases to 9%, whereas pathologic and radiologic series have reported the frequency of pure flat epithelial atypia ranging from 3.6% to 7.6% [10][11][12][13]. Radiologic description of flat epithelial atypia is scant in the literature [14,15].…”

Section: Discussionmentioning

confidence: 80%

Flat Epithelial Atypia of the Breast: Pathological-Radiological Correlation

Solorzano

Mesurolle

Omeroglu

et al. 2011

American Journal of Roentgenology

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“…There are two histological types: one with the cytological features of low-grade ductal carcinoma in situ (DCIS) with insufficient architectural atypia, and the other called 'mini-DCIS' with similar cytology and architectural atypia but of a smaller size (<2 mm) [3]. It is difficult to histologically differentiate between ADH and DCIS [4].…”

Section: Discussionmentioning

confidence: 99%

“…The reported rate of underestimation of carcinoma in CNB-diagnosed ADH is as high as 48% [3-8]. Therefore, complete surgical excision is generally recommended for ADH lesions diagnosed using CNB.…”

Section: Introductionmentioning

confidence: 99%

Validation of a Scoring System for Predicting Malignancy in Patients Diagnosed with Atypical Ductal Hyperplasia Using an Ultrasound-Guided Core Needle Biopsy

Kim

Han

et al. 2012

J Breast Cancer

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PurposeThe need for surgical excision in patients with ultrasound-guided core needle biopsy (CNB)-diagnosed atypical ductal hyperplasia (ADH) remains an issue of debate. The present study sought to validate a scoring system (the U score, for underestimation) that we have previously developed for predicting malignancy in CNB-diagnosed ADH.MethodsThe study prospectively enrolled 85 female patients with CNB-diagnosed ADH who underwent subsequent surgical excision. Underestimation was defined as a surgical specimen having malignant foci.ResultsThe overall underestimation rate was 37% (31/85). Multivariate analysis showed that a clinically palpable mass, microcalcification on imaging, size >15 mm and a patient age of ≥50 years were independently associated with underestimation. When applied to the scoring system, the validation score was significant (p<0.001; area under the curve, 0.852). No patient with a U score <3.5 had an underestimated lesion.ConclusionThe present study successfully validated the efficacy of our scoring system for predicting malignancy in CNB-diagnosed ADH. A U score of ≤3.5 indicates that surgical excision may not be necessary.

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Flat Epithelial Atypia and Atypical Ductal Hyperplasia: Carcinoma Underestimation Rate

Cited by 61 publications

References 35 publications

Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Flat Epithelial Atypia of the Breast: Pathological-Radiological Correlation

Validation of a Scoring System for Predicting Malignancy in Patients Diagnosed with Atypical Ductal Hyperplasia Using an Ultrasound-Guided Core Needle Biopsy

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