J Cancer 2016; 7(1):1-6. doi:10.7150/jca.12781 This issue
1. Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX;
2. Department of Surgery, Madigan Military Medical Center, Fort Lewis, WA;
3. Department of Surgical Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, TX;
4. Qwest Care Associates, Intensive Care Unit, Metropolitan Methodist Hospital, San Antonio, TX;
5. Department of Radiology, San Antonio Military Medical Center, Fort Sam Houston, TX;
6. Department of Pathology, San Antonio Military Medical Center, Fort Sam Houston, TX;
7. Director, Cancer Vaccine Development Program, San Antonio, TX, USA.
Background: The optimal treatment of flat epithelial atypia (FEA) found on breast core needle biopsy (CNB) is controversial. We performed a retrospective review of our institutional experience with FEA to determine if excisional biopsy may be deferred.
Methods: Surgical records from 2009 to 2012 were reviewed for FEA diagnosis. After exclusion for concomitant lesions, CNBs of pure FEA were classified using a previously agreed upon descriptor of “focal” versus “prominent”. Data was analyzed with the Fisher's Exact and Student-t test as appropriate.
Results: Of 71 CNBs evaluated, pure FEA was identified on 27 CNBs. Final excisional biopsy was benign in 24 of 27 cases (88%) with associated ductal carcinoma in-situ (DCIS) in 3 of 27 cases (11%). Eighteen of 27 (67%) CNBs were classified as focal while 9 (33%) were described as prominent. Zero of the 18 focal patients had a malignancy compared to 3 of the 9 in the prominent group (0% vs 33%, p=0.02). Of the 27 pure FEA CNBs, 6 patients had a personal history of breast carcinoma, five DCIS and one invasive ductal carcinoma. No malignancies were found in the 21 patients without a personal history of breast carcinoma versus three in the patients with a positive history (0/21 v 3/6, p=0.007).
Conclusions: Our data suggests those women who have adequate sampling and sectioning of CNBs, with focal, pure FEA on pathology, and are without a personal history of breast cancer may undergo a period of imaging surveillance. Conversely, patients with a history of breast cancer or pure, prominent FEA on CNB disease should proceed to excisional biopsy.
Keywords: Pure Flat Epithelial Atypia, Ductal Intraepithelial Neoplasia, Pure FEA, DIN 1A, Columnar Cell Change with atypia, Columnar Cell Hyperplasia with Atypia.