Surgical implications and variability in the use of the flat epithelial atypia diagnosis on breast biopsy specimens

Abstract

Objectives Flat epithelial atypia (FEA) is a relatively new diagnostic term with uncertain clinical significance for surgical management. Any implied risk of invasive breast cancer associated with FEA is contingent upon diagnostic reproducibility, yet little is known regarding its use. Materials and Methods Pathologists in the Breast Pathology Study interpreted one of four 60-case test sets, one slide per case, constructed from 240 breast biopsy specimens. An electronic data form with standardized diagnostic categories was used; participants were instructed to indicate all diagnoses present. We assessed participants’ use of FEA as a diagnostic term within: 1) each test set; 2) 72 cases classified by reference as benign without FEA; and 3) six cases classified by reference as FEA. 115 pathologists participated, providing 6,900 total independent assessments. Results Notation of FEA ranged from 0% to 35% of the cases interpreted, with most pathologists noting FEA on 4 or more test cases. At least one participant noted FEA in 34 of the 72 benign non-FEA cases. For the 6 reference FEA cases, participant agreement with the case reference FEA diagnosis ranged from 17% to 52%; diagnoses noted by participating pathologists for these FEA cases included columnar cell hyperplasia, usual ductal hyperplasia, atypical lobular hyperplasia, and atypical ductal hyperplasia. Conclusions We observed wide variation in the diagnosis of FEA among U.S. pathologists. This suggests that perceptions of diagnostic criteria and any implied risk associated with FEA may also vary. Surgical excision following a core biopsy diagnosis of FEA should be reconsidered and studied further.

Spectrum of Flat Epithelial Atypia in Breast Lesions

“…Hence, the screening for breast cancer should be started at an early age. The patients at risk, for instance, those who are chronic smokers or suffering from obesity, users of oral contraceptive pills, physical inactivity, or have a strong family history of this malignancy, should be taken into 18,22 consideration and addressed thoroughly. According to available statistics from various studies, the rate of upgrade of FEA to invasive malignancy varies from 2.4% to 20%.…”

Modified Lateral Oncoplastic Surgery for Giant Breast Fibroadenoma with Flat Epithelial Atypia: A Case Report

“…It is of uncertain clinical significance but pure FEA patients showed association with cancer in a meta-analysis. [5,6] In this report, we present a case of GFA with focal FEA with no association with cancer, in outer half of left breast managed with modified LOBS with good cosmesis. This work has been reported in line with SCARE criteria.…”

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

“…Another point that merits consideration when discussing the histologic features of CCLs is their diagnostic reproducibility. Samples et al assessed interobserver agreement of 29–30 pathologists for the diagnosis of six reference cases of FEA [ 63 ]. The rate of agreement with the reference diagnosis ranged from 17% to 52% with the reference panel pathologists demonstrating substantial variability in their interpretation of FEA.…”