title: 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.
authors.affiliation: Division of Pathological Anatomy, Department of Medical and Surgical Critical Care, AOU Careggi, University of Florence, Largo GA Brambilla 3, 50134 Florence, Italy. simonetta.bianchi@unifi.it
authors.forename: Simonetta
authors.initials: S
authors.lastname: Bianchi
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bendinelli
authors.forename: Isabella
authors.initials: I
authors.lastname: Castellano
authors.forename: Quirino
authors.initials: Q
authors.lastname: Piubello
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Renne
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Cattani
authors.forename: Domenica
authors.initials: D
authors.lastname: Di Stefano
authors.forename: Giovanna
authors.initials: G
authors.lastname: Carrillo
authors.forename: Licia
authors.initials: L
authors.lastname: Laurino
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bersiga
authors.forename: Carmela
authors.initials: C
authors.lastname: Giardina
authors.forename: Stefania
authors.initials: S
authors.lastname: Dante
authors.forename: Carla
authors.initials: C
authors.lastname: Di Loreto
authors.forename: Carmela
authors.initials: C
authors.lastname: Quero
authors.forename: Concetta Maria
authors.initials: CM
authors.lastname: Antonacci
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
mesh_terms: D062005:Biopsy, Large-Core Needle / Q000379:methods*; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000473:pathology; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis / Q000473:pathology; D016015:Logistic Models; D008875:Middle Aged; D011237:Predictive Value of Tests; D013238:Stereotaxic Techniques; D014618:Vacuum