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...
Methods and materials
Study population
We reviewed our database of all stereotactically (n=724) and sonographically (n=521) vacuum assisted biopsy procedures performed in our hospital between January 2007 and December 2010.
We included in the study 45 lesions (45 patients) biopsied under stereotactic (n=34) and sonographic (n=11) VAB guidance in which FEA was the most advanced lesion at pathologic examination.
All 45 patients underwent surgical excision (n=27) or a minimum of 2 years´ imaging follow-up (n=18).
The patient´s age,
personal history of breast cancer,
clinical presentation (if the lesion...
Results
RESULTS
Of the 1245 vacuum-assisted biopsies,
45 yielded FEA (3.6 %).
Thirty-four of 45 FEA were obtained under stereotactic guidance (75 %) and 11 under sonographic guidance (25 %).
Clinical Findings
The average patient age was 49 years (range,
37-67 years).
FEA was found during the staging of a synchronous cancer in the same breast in two patients.
One patient had a history of previous cancer in the contralateral breast.
Six patients had familial history of breast cancer.
Six of the 45 lesions were palpable....
Conclusion
In this study of 45 vacuum-biopsied FEA,
the underestimation rate was 6.7 % (3/45).
We conclude that a diagnosis of FEA with vacuum-assisted biopsy requires surgical excision,
but the size of the lesion and the percentage of microcalcifications removed may be helpful in predicting the possibility of upgrade to malignancy.
References
Azzopardi JG.
Clinging carcinoma.
Problems in breast pathology.
London,
UK: WB Saunders,
1979:193-203
Tavassoli FA,
Hoeffler H,
Rosai J,
et al.
Intraductal proliferative lesions.
World Health Organization classification of tumours: pathology and genetics of tumours of the breast and female genital organs.
Lyon,
France: IARC Press,
2003:63–73
Moinfar F.
Flat ductal intraepithelial neoplasia of the breast: a review of diagnostic criteria,
differential diagnoses,
molecular-genetic findings,
and clinical relevance—it is time to appreciate the Azzopardi concept! Arch Pathol Lab Med 2009; 133:879–892
Kunju LP,
Kleer CG....