Flat Epithelial Atypia in Breast Core Needle Biopsies With Radiologic-Pathologic Concordance

Abstract

Flat epithelial atypia (FEA) is an alteration of terminal duct-lobular units by a proliferation of ductal epithelium with low grade atypia. No consensus exists on whether the diagnosis of FEA in core needle biopsy (CNB) requires excision (EXC). We retrospectively identified all in-house CNBs obtained between 1/2012-7/2018 with FEA. We reviewed all CNB slides and assessed radiologic-pathologic concordance. An upgrade was defined as invasive carcinoma (IC) and/or ductal carcinoma in situ in the EXC. The EXC slides of all upgraded cases were re-reviewed. Out of ~15,700 consecutive CNBs in the study period, 106 CNBs from 106 patients yielded FEA alone or with classic lobular neoplasia (LN). We excluded 52 CNBs (40 patients with prior/concurrent carcinoma and 12 without EXC). After re-review, we reclassified 14 cases (2 marked nuclear atypia, 10 focal ADH, 2 benign). The final FEA study cohort consisted of 40 CNBs from 40 women. The CNB targeted mammographic calcifications in 36 (90%) cases, MRI non-mass enhancement in 3 (8%), and 1 (2%) sonographic mass. All CNBs were deemed radiologicpathologic concordant. FEA was present alone in 34 CNBs and with LN in 6. EXC yielded 2 low grade IC, each spanning less than 2 mm, identified in tissue sections without biopsy site changes. The remaining 38 cases had no upgrade. Classic LN did not affect the upgrade. The upgrade rate of FEA was 5%; both minute, low-grade "incidental" IC. We conclude that non-surgical management may be considered in patients without prior/concurrent carcinoma and radiologicpathologic concordant CNB diagnosis of FEA.

Tomosynthesis-Guided Vacuum-Assisted Breast Biopsy of Architectural Distortion Without a Sonographic Correlate: A Retrospective Review

“…Historically, excisional biopsy has been recommended after a core needle biopsy diagnosis of all high risk lesions. Recent data suggest that upgrade rates to carcinoma in situ or invasive carcinoma are 4-23% for lobular neoplasia [27,28], up to 29% for ADH [18], 3-5% for flat epithelial atypia [29,30], 2-6% for papilloma without atypia [31][32][33], and 2-28% for radial scar [34] [35]. Most of these studies found that…”

Are Columnar Cell Lesions the Earliest Non-Obligate Precursor in the Low-Grade Breast Neoplasia Pathway?

“…CCLs are most frequently identified in CNBs performed for mammographically detected calcifications. While the majority of CCLs manifest as grouped amorphous calcifications, fine pleomorphic or punctate calcifications can also be observed [ 2 , 3 , 6 , 8 , 9 , 10 , 32 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. The calcifications associated with CCLs may be indistinguishable from other causes of suspicious calcifications such as ADH or DCIS, necessitating biopsy or excision for diagnosis [ 2 ].…”

“…Sonographically, CCLs with and without atypia may present as cystic or solid lesions as well as a mass with irregular, microlobulated or indistinct borders and hypoechoic or complex echotexture [ 2 , 38 , 39 , 43 , 45 , 46 ]. There are no reported specific mammographic or ultrasound features which aid in the distinction of patients with CCLs with or without atypia [ 2 , 45 ].…”

“…Although there is a dearth of literature with regards to magnetic resonance imaging (MRI) features in CCLs, findings described include non-mass enhancement (NME) [ 38 , 51 ] and irregular clumped enhancement [ 46 ]. Santucci et al describe a series of 139 patients with histologic borderline (B3) lesions, of which 31 (14.39%) were diagnosed as FEA [ 47 ].…”

Machine learning-based image analysis for accelerating the diagnosis of complicated preneoplastic and neoplastic ductal lesions in breast biopsy tissues

“…Additionally, CCLs, including columnar cell hyperplasia, have similar neoplastic genetic alterations [30,31]. At present, CCL cases need to be followed up closely [32][33][34]. Therefore, distinguishing CCLs from normal mammary glands is important for breast biopsy tissue.…”