Flat epithelial atypia on core needle biopsy does not always mandate excisional biopsy

Srour, Marissa K.; Donovan, Cory; Chung, Alice; Harit, Attiya; Dadmanesh, Farnaz; Giuliano, Armando E.; Amersi, Farin

doi:10.1111/tbj.13507

Cited by 10 publications

(5 citation statements)

References 20 publications

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“…The literature shows much lower rates of upgrade in pure FEA lesions that have radiological and pathological concordance. [35][36][37][38] We are limited by small sample size and may consider a more conservative approach to FEA if our future data becomes consistent with the literature.…”

Section: Discussionmentioning

confidence: 78%

B3 lesion upgrade rates in a tertiary Australian breast centre: a 8‐year experience (2012–2019)

Huang

Park

McLaren

et al. 2020

ANZ Journal of Surgery

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Background: B3 breast lesions identified on core needle biopsy have uncertain malignant potential. Traditional management of these lesions has been surgical excision, but there is growing interest in less invasive and more cost-effective alternatives such as vacuumassisted excisional biopsy (VAEB). Determining the rate of malignant upgrade for B3 lesions is important as it may identify low-risk lesions where VAEB could be considered. Methods: A retrospective study was conducted of women undergoing an elective excisional biopsy for a B3 lesion identified on core needle biopsy at a tertiary Australian breast centre. The pre-operative biopsy diagnosis and subsequent excisional biopsy diagnosis were used to calculate the proportion of cases where the diagnosis was upgraded to malignancy. Results: A total of 299 eligible patients were identified. Pre-operative diagnosis of papillary lesion with atypia was associated with the highest upgrade rate (50%, n = 12). The next highest upgrade rates occurred in those with flat epithelial atypia (37.50%, n = 8); atypical ductal hyperplasia (24.71%, n = 85); lobular carcinoma in situ (LCIS)/atypical lobular hyperplasia with calcification (17.65%, n = 17); and papillary lesion without atypia (4.72%, n = 106). Patients with radial scar (n = 51), classical LCIS without calcification (n = 7) and mucocoele-like lesion (n = 8) had a 0% upgrade rate. Conclusion: VAEB may be appropriate for low malignant risk lesions such as papillary lesion without atypia, mucocoele-like lesion and radial scar lesion without atypia. Opensurgical-excisional biopsy remains appropriate for high upgrade lesions such as atypical ductal hyperplasia, papillary lesion with atypia, flat epithelial atypia and classical LCIS with calcification. Long-term prospective randomized multicentre studies and continuing multidisciplinary approach is recommended for future clinical implementation.

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Section: Discussionmentioning

confidence: 78%

B3 lesion upgrade rates in a tertiary Australian breast centre: a 8‐year experience (2012–2019)

Huang

Park

McLaren

et al. 2020

ANZ Journal of Surgery

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“…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…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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

Ambinder

Plotkin

Euhus

et al. 2021

American Journal of Roentgenology

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The publication of this Accepted Manuscript is provided to give early visibility to the contents of the article, which will undergo additional copyediting, typesetting, and review before it is published in its final form. During the production process, errors may be discovered that could affect the content of the Accepted Manuscript. All legal disclaimers that apply to the journal pertain. The reader is cautioned to consult the definitive version of record before relying on the contents of this document.

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“…FEA is often seen in combination with other high-risk lesions and is suggested to be a precursor lesion to both ADH and carcinoma [ 38 , 39 ]. Srour et al found a statistically significant increase in UR for FEA with ADH (18.6%) compared to pure FEA alone (3.2%) [ 40 ]. This finding is supported by Liu et al who demonstrated that pure FEA had a zero rate of upstage to malignancy and the presence of concurrent ADH or RS with FEA had an increased UR [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of delay of excisional biopsy on upstage rate for atypical ductal hyperplasia, flat epithelial atypia, intraductal papilloma, and radial scar

Casaubon

Niakan

Vicks

et al. 2022

Breast Cancer Res Treat

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Purpose When Core Needle Biopsy (CNB) demonstrates Atypical Ductal Hyperplasia (ADH), Flat Epithelial Atypia (FEA), Intraductal Papilloma (IDP), or Radial Scar/Complex Sclerosing Lesion (RS), excisional biopsy (EB) is often performed to rule out underlying malignancy with upstage rates (UR) ranging between 1 and 20%. The COVID-19 pandemic led to delayed EB for many patients. We sought to evaluate whether this delay was associated with higher UR. Methods We performed a retrospective analysis of women who underwent CNB and then EB for ADH, FEA, IDP, or RS between 2017 and 2021 using an IRB-approved repository. UR was evaluated by days between CNB and EB. Results 473 patients met inclusion. 55 were upstaged to cancer (11.6%). 178 patients had pure ADH on CNB and 37 were upstaged (20.8%). 50 patients had pure FEA and 3 were upstaged (6%). 132 had pure IDP and 7 were upstaged (5.3%). 98 had pure RS and 1 was upstaged (1%). 7/15 (46.7%) had a combination of diagnoses or diagnosis with palpable mass and were upstaged. Days between CNB and EB were < 60 for 275 patients (58.1%), 60–90 for 108 (22.8%), 91–120 for 43 (9.1%), and > 120 for 47 (9.9%). There was no significant difference in UR (10.9% for < 60, 14.8% for 60–90, 7% for 90–120, and 12.8% for > 120, p = 0.54). UR for ADH was clinically increased after 60 days (27.8 vs. 17.5%), but this did not reach statistical significance ( p = 0.1). Conclusion Surgical delay was not associated with an increased UR.

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Flat epithelial atypia on core needle biopsy does not always mandate excisional biopsy

Cited by 10 publications

References 20 publications

B3 lesion upgrade rates in a tertiary Australian breast centre: a 8‐year experience (2012–2019)

B3 lesion upgrade rates in a tertiary Australian breast centre: a 8‐year experience (2012–2019)

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

The effect of delay of excisional biopsy on upstage rate for atypical ductal hyperplasia, flat epithelial atypia, intraductal papilloma, and radial scar

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