Positive predictive value for malignancy of pure flat epithelial atypia diagnosis by percutaneous needle biopsy of the breast: management of FEA in ultrasonography.
BACKGROUND
Some reports suggest that the rate of definitive diagnosis of malignant tumors, namely, the final diagnosis being revised to a higher stage, in patients diagnosed as having flat epithelial atypia (FEA) by percutaneous needle biopsy of the breast (PNB) is as low as 0-3 %. However, other reports suggest that the rate is as high as 10 % or more, bringing confusion on this issue. We examined the positive predictive value for malignancy in the patients diagnosed as having pure FEA and the patients' radiolopathological characteristics observed in our hospital.


METHODS
Of the patients who underwent PNB in our facility, those who were diagnosed as having pure FEA were recruited as the subjects of this study.


RESULTS
Of the 4,197 consecutive patients who underwent PNB, 44 (1.0 %) were diagnosed as having pure FEA following a re-examination. Among 44 cases, 39 cases were selected as the subjects of this study. Among the 39 patients, six patients were diagnosed as having malignant lesions, two of whom had invasive carcinoma of no special type (papillotubular type), one had tubular carcinoma, one had ductal carcinoma in situ (DCIS) of high nuclear grade, one had DCIS of intermediate nuclear grade, and one had DCIS of low nuclear grade. The diameters of 6 malignant lesions were 10-30 mm at ultrasonography (US) examination. Five of the 39 patients had contralateral breast cancer.


CONCLUSIONS
The positive predictive value for malignancy of pure FEA was 15.7 %. The patients with pure FEA may make a follow up without an excisional biopsy when the lesion sizes less than 10 mm on US examination.
Department of Pathology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan. ichirou@marianna-u.ac.jp.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan. ichirou@marianna-u.ac.jp.
Ichiro
I
Maeda
Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Yoshihide
Y
Kanemaki
Breast Center, Kameda Medical Center, Kamogawa, Japan.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Mitsuhiro
M
Tozaki
Department of Pathology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Hirotaka
H
Koizumi
Department of Pathology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Yoshiyasu
Y
Oana
Department of Pathology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Yuko
Y
Okanami
Breast Center, Kameda Medical Center, Kamogawa, Japan.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Kyoko
K
Tsuchiya
Breast Center, Kameda Medical Center, Kamogawa, Japan.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Arata
A
Shimo
Breast Center, Kameda Medical Center, Kamogawa, Japan.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Yasuyuki
Y
Kojima
Breast Center, Kameda Medical Center, Kamogawa, Japan.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Ryousuke
R
Hayami
Breast Center, Kameda Medical Center, Kamogawa, Japan.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Toru
T
Nishikawa
Breast Center, Kameda Medical Center, Kamogawa, Japan.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Hisanori
H
Kawamoto
Breast Center, Kameda Medical Center, Kamogawa, Japan.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Yukari
Y
Yabuki
Breast Center, Kameda Medical Center, Kamogawa, Japan.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Koichiro
K
Tsugawa
Department of Pathology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan.|Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Masayuki
M
Takagi
D000328:Adult; D001707:Biopsy, Needle / Q000379:methods*; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000473:pathology; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D008875:Middle Aged; D016217:Ultrasonography, Mammary
Biopsy; Breast; Columnar cell hyperplasia; DCIS; Flat epithelial atypia