|ECR 2015 / C-0632|
|Is excisional biopsy warranted after a diagnosis of flat epitelial atypia (FEA) at vacuum-assisted biopsy?|
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Aims and objectives
The development of mammographic screening programs has led to a considerable increase in the number of biopsies performed for subclinical mammographic abnormalities, mainly microcalcifications. As a consequence, a diagnosis of ” flat epithelial atypia” (FEA) is increasingly frequent.
FEA is not a new entity. It was described in 1979 as a distinctive intraepithelial neoplastic lesion breast lesion, which was named “clinging carcinoma in situ” (1). Since then, it has received a wide variety of appellations such as “atypical ductal cells with apocrine snouts”, “atypical cystic lobules” and “well-differentiated DCIS with a clinging architecture”, to name a few. Given the lack of a unified nomenclature, in 2003, the World Health Organization Working Group on the Pathology and Genetics of Tumors of the Breast, introduced the term FEA (2).
As defined by the WHO, FEA is an “intraductal alteration characterized by replacement of the native epithelial cells by a single or 3-5 layers of monotonous atypical cuboidal to columnar cells with apical snouts. The ducts involved are variably distended and often contain intraluminal microcalcifications or secretory material” (1-4).
FEA is distinguished from columnar cell change and columnar cell hyperplasia by the presence of mild cytologic atypia and from atypical ducal hyperplasia and ductal carcinoma in situ by the absence of architectural atypia (1,5,6).
The management of FEA after a percutaneous biopsy is discussed, ranging from imaging follow-up to open surgical biopsy. However, the use of vacuum-assisted biopsy (VAB) systems instead of 14G automatic gun, especially for performing stereotactic biopsies in case of microcalcifications, supposes a lower frequency of histologic underestimation (7) and a lower false-negative results, with an overall improvement in lesion characterization.
The aim of this study was to determine the frequency of malignancy after surgical excision of vacuum-assisted biopsy-proven FEA, and to evaluate the outcome of lesions that were followed up instead of surgically excised.
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