title: Flat epithelial atypia and atypical ductal hyperplasia: carcinoma underestimation rate.
abstract: This study was carried out to determine the underestimation rate of carcinoma upon surgical biopsy after a diagnosis of flat epithelial atypia and atypical ductal hyperplasia and 11-gauge vacuum-assisted breast biopsy. A retrospective review was conducted of 476 vacuum-assisted breast biopsy performed from May 2005 to January 2007 and a total of 70 cases of atypia were identified. Fifty cases (71%) were categorized as pure atypical ductal hyperplasia, 18 (26%) as pure flat epithelial atypia and two (3%) as concomitant flat epithelial atypia and atypical ductal hyperplasia. Each group were compared with the subsequent open surgical specimens. Surgical biopsy was performed in 44 patients with atypical ductal hyperplasia, 15 patients with flat epithelial atypia, and two patients with flat epithelial atypia and atypical ductal hyperplasia. Five cases of atypical ductal hyperplasia were upgraded to ductal carcinoma in situ, three cases of flat epithelial atypia yielded one ductal carcinoma in situ and two cases of invasive ductal carcinoma, and one case of flat epithelial atypia/atypical ductal hyperplasia had invasive ductal carcinoma. The overall rate of malignancy was 16% for atypical ductal hyperplasia (including flat epithelial atypia/atypical ductal hyperplasia patients) and 20% for flat epithelial atypia. The presence of flat epithelial atypia and atypical ductal hyperplasia at biopsy requires careful consideration, and surgical excision should be suggested.
authors.affiliation: Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Italy. annaingegnoli@yahoo.it
authors.forename: Anna
authors.initials: A
authors.lastname: Ingegnoli
authors.forename: Cecilia
authors.initials: C
authors.lastname: d'Aloia
authors.forename: Antonia
authors.initials: A
authors.lastname: Frattaruolo
authors.forename: Lara
authors.initials: L
authors.lastname: Pallavera
authors.forename: Eugenia
authors.initials: E
authors.lastname: Martella
authors.forename: Girolamo
authors.initials: G
authors.lastname: Crisi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zompatori
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology; D018270:Carcinoma, Ductal, Breast / Q000453:epidemiology / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000453:epidemiology / Q000473:pathology; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment