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Morphological parameters of flat epithelial atypia (FEA) in stereotactic vacuum-assisted needle core biopsies do not predict the presence of malignancy on subsequent surgical excision

Abstract

Flat epithelial atypia (FEA) may represent the earliest precursor of low-grade breast cancer and often coexists with more advanced atypical proliferative breast lesions such as atypical ductal hyperplasia (ADH) and lobular intraepithelial neoplasia (LIN). The present study aims to investigate the association between morphological parameters of FEA and presence of malignancy at surgical excision (SE) and the clinical significance of the association of FEA with ADH and/or LIN. This study included 589 cases of stereotactic 11-gauge vacuum-assisted needle core biopsy (VANCB), reporting a diagnosis of FEA, ADH or LIN with subsequent SE from 14 pathology departments in Italy. Available slides were reviewed, with 114 (19.4 %) showing a malignant outcome at SE. Among the 190 cases of pure FEA, no statistically significant association emerged between clinical–pathological parameters of FEA and risk of malignancy. Logistic regression analyses showed an increased risk of malignancy according to the extension of ADH among the 275 cases of FEA associated with ADH (p = 0.004) and among the 34 cases of FEA associated with ADH and LIN (p = 0.02). In the whole series, a statistically significant increased malignancy risk emerged according to mammographic R1–R3/R4–R5 categories (OR = 1.56; p = 0.04), extension (OR = 1.24; p = 0.04) and grade (OR = 1.94; p = 0.004) of cytological atypia of FEA. The presence of ADH was associated with an increased malignancy risk (OR = 2.85; p < 0.0001). Our data confirm the frequent association of FEA with ADH and/or LIN. A diagnosis of pure FEA on VANCB carries a 9.5 % risk of concurrent malignancy and thus warrants follow-up excision because none of the clinical–pathological parameters predicts which cases will present carcinoma on SE.

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References

  1. 1.

    Bianchi S, Caini S, Renne G et al (2011) Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): a large multi-institutional study in Italy. Breast 20:264–270

  2. 2.

    Tavassoli FA, Hoefler H, Rosai J et al (2003) Intraductal proliferative lesions. In: Tavassoli FA, Devilee P (eds) Pathology and genetics of tumours of the breast and female genital organs. IARC, Lyon, pp 63–73

  3. 3.

    Monfair F (2010) 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 133:879–892

  4. 4.

    Azzopardi JP (1979) Problems in breast pathology. Saunders, London, pp 193–203

  5. 5.

    Simpson PT, Gale T, Reis-Filho JS et al (2005) Columnar cell lesions of the breast: the missing link in breast cancer progression? A morphological and molecular analysis. Am J Surg Pathol 29:734–746

  6. 6.

    Bombonati A, Sgroi DC (2011) The molecular pathology of breast cancer progression. J Pathol 223:307–317

  7. 7.

    Brogi E, Oyama T, Koerner FC (2001) Atypical cystic lobules in patients with lobular neoplasia. Int J Surg Pathol 9:201–206

  8. 8.

    Abdel-Fatah TMA, Powe DG, Hodi Z et al (2007) High frequency of coexistence of columnar cell lesions, lobular neoplasia, and low grade ductal carcinoma in situ with invasive tubular carcinoma and invasive lobular carcinoma. Am J Surg Pathol 31:417–426

  9. 9.

    Collins LC, Achacoso NA, Nekhlydov L et al (2007) Clinical and pathologic features of ductal carcinoma in situ associated with the presence of flat epithelial atypia: an analysis of 543 patients. Mod Pathol 20:1149–1155

  10. 10.

    Leibl S, Regitnig P, Monfair F (2007) Flat epithelial atypia (DIN 1a, atypical columnar change): an underdiagnosed entity very frequently coexisting with lobular neoplasia. Histopathology 50:859–865

  11. 11.

    Kunju LP, Kleer CG (2007) Significance of flat epithelial atypia on mammotome core needle biopsy: should it be excised? Hum Pathol 38:35–41

  12. 12.

    Lee TYJ, MacIntosh RF, Rayson D et al (2010) Flat epithelial atypia on breast needle core biopsy: a retrospective study with clinical–pathological correlation. Breast J 16:377–383

  13. 13.

    Boulos FI, Dupont WD, Simpson JF et al (2008) Histologic associations and long-term cancer risk in columnar cell lesions of the breast. A retrospective cohort and a nested case–control study. Cancer 113:2415–2421

  14. 14.

    Aroner SA, Collins LC, Schnitt SJ et al (2010) Columnar cell lesions and subsequent breast cancer risk: a nested case–control study. Breast Cancer Res 12:R61, http://breast-cancer-research.com/content/12/4/R61

  15. 15.

    Verschuur-Maes AHJ, Van Deurzen CHM, Monninkhof EM et al (2012) Columnar cell lesions on breast needle biopsies: is surgical excision necessary? A systematic review. Ann Surg 255:259–265

  16. 16.

    Lazarus E, Mainiero MB, Schepps B et al (2006) BI-RADS lexicon for US and mammography: interobserver variability and positive predictive value. Radiology 239:385–391

  17. 17.

    Pinder SE, Reis-Filho JS (2007) Non-operative breast pathology: columnar cell lesions. J Clin Pathol 60:1307–1312

  18. 18.

    Pinder SE, Provenzano E, Reis-Filho JS (2007) Lobular in situ neoplasia and columnar cell lesions: diagnosis in breast core biopsies and implications for management. Pathology 39:208–216

  19. 19.

    Schnitt SJ, Vincent-Salomon A (2003) Columnar cell lesions of the breast. Adv Anat Pathol 10:113–124

  20. 20.

    PageDL Rogers LW (1992) Combined histologic and cytologic criteria for the diagnosis of mammary atypical ductal hyperplasia. Hum Pathol 23:1095–1097

  21. 21.

    Rosen PP, Hoda SA (2010) Breast pathology: diagnosis by needle core biopsy. Lippincott Williams & Wilkins, Philadelphia

  22. 22.

    Cangiarella J, Guth A, Axelrod D et al (2008) Is surgical excision necessary for the management of atypical lobular hyperplasia and lobular carcinoma in situ diagnosed on core needle biopsy? A report of 38 cases and review of the literature. Arch Pathol lab Med 32:979–983

  23. 23.

    Ely KA, Carter BA, Jensen RA et al (2001) Core biopsy of the breast with atypical ductal hyperplasia. A probabilistic approach to reporting. Am J Surg Pathol 25:1017–1021

  24. 24.

    Wagoner MJ, Laronga C, Acs G (2009) Extent and histologic pattern of atypical ductal hyperplasia present on core needle biopsy specimens of the breast can predict ductal carcinoma in situ in subsequent excision. Am J Clin Pathol 131:112–121

  25. 25.

    Martel M, Barron-Rodriquez P, Tolgay Ocal I et al (2007) Flat DIN 1 (flat epithelial atypia) on core needle biopsy: 63 cases identified retrospectively among 1751 core biopsies performed over an 8-year period (1992–1999). Virchows Arch 451:883–891

  26. 26.

    Piubello Q, Parisi A, Eccher A et al (2009) Flat epithelial atypia on core needle biopsy: which is the right management? Am J Surg Pathol 33:1078–1084

  27. 27.

    Lavoué V, Roger CM, Poilblanc M et al (2011) Pure flat atypia (DIN 1a) on core needle biopsy: study of 60 biopsies with follow-up surgical excision. Breast Cancer Res Treat 125:121–126

  28. 28.

    Senetta R, Campanino PP, Mariscotti G et al (2009) Columnar cell lesions associated with breast calcifications on vacuum-assisted core biopsies: clinical, radiographic, and histological correlations. Mod Pathol 22:762–769

  29. 29.

    Noel JC, Buxant F, Engohan-Aloghe C (2010) Immediate surgical resection of residual microcalcifications after a diagnosis of pure flat epithelial atypia on core biopsy: a word of caution. Surg Oncol 19:243–246

  30. 30.

    Chivukula M, Bhargava R, Tseng G et al (2009) Clinicopathologic implications of “flat epithelial atypia” in core needle biopsy specimens of the breast. Am J Clin Pathol 131:802–808

  31. 31.

    Sudarshan M, Meguerditchian AN, Mesorulle B et al (2011) Flat epithelial atypia of the breast: characteristics and behaviours. Am J Surg 201:245–250

  32. 32.

    Rosen PP (1999) Columnar cell hyperplasia is associated with lobular carcinoma in situ and tubular carcinoma. Am J Surg Pathol 23:1561

  33. 33.

    Sahoo S, Recant WM (2005) Triad of columnar cell alteration, lobular carcinoma in situ, and tubular carcinoma of the breast. Breast J 11:140–142

  34. 34.

    Lerwill MF (2008) Flat epithelial atypia of the breast. Arch Pathol Lab Med 132:615–621

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Acknowledgments

Pathologists contributing to VANCB Study Group: Antonacci CM (Milano), Bersiga A (Cremona), Bianchi S (Firenze), Carrillo G (Napoli), Castellano I (Torino), Cattani MG (Bologna), Dante S (Vicenza), Di Loreto C (Udine), Di Stefano D (Roma), Ferrero G (Cremona), Giardina C (Bari), Laurino L (Treviso), Piubello Q (Verona), Querzoli P (Ferrara), Renne G (Milano), Sapino A (Torino), Vezzosi V (Firenze). Radiologists contributing to VANCB Study Group: Amadori S (Milano), Ambrogetti D (Firenze), Balestrieri N (Treviso), Bazzocchi M (Udine), Bodini MT (Cremona), Cassano E (Milano), Durando M (Torino), Festa R (Napoli), Guerrieri AM (SARIS, Bari), Maggian P (Vicenza), Mariscotti G (Torino), Mattei M (Roma), Montemezzi S (Verona), Saguatti G (Bologna), Scalabrin U (Vicenza), Trasente I (Napoli), Ventrella V (Bari)

Funding source

This work was supported by a grant from the “Ente Cassa di Risparmio” of Florence-Italy.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Correspondence to Simonetta Bianchi.

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Bianchi, S., Bendinelli, B., Castellano, I. et al. Morphological parameters of flat epithelial atypia (FEA) in stereotactic vacuum-assisted needle core biopsies do not predict the presence of malignancy on subsequent surgical excision. Virchows Arch 461, 405–417 (2012). https://doi.org/10.1007/s00428-012-1279-y

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Keywords

  • Breast
  • Flat epithelial atypia
  • Stereotactic vacuum-assisted needle core biopsy
  • Surgical excision
  • Malignancy