title: Analysis of Clinical and Pathologic Factors of Pure, Flat Epithelial Atypia on Core Needle Biopsy to Aid in the Decision of Excision or Observation.
abstract: 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.
authors.affiliation: 1. Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX;
authors.forename: John S
authors.initials: JS
authors.lastname: Berry
authors.affiliation: 1. Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX;
authors.forename: Alfred F
authors.initials: AF
authors.lastname: Trappey
authors.affiliation: 1. Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX;
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Vreeland
authors.affiliation: 2. Department of Surgery, Madigan Military Medical Center, Fort Lewis, WA;
authors.forename: Adam R
authors.initials: AR
authors.lastname: Pattyn
authors.affiliation: 3. Department of Surgical Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, TX;
authors.forename: Guy T
authors.initials: GT
authors.lastname: Clifton
authors.affiliation: 4. Qwest Care Associates, Intensive Care Unit, Metropolitan Methodist Hospital, San Antonio, TX;
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Berry
authors.affiliation: 1. Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX;
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Schneble
authors.affiliation: 5. Department of Radiology, San Antonio Military Medical Center, Fort Sam Houston, TX;
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Kirkpatrick
authors.affiliation: 6. Department of Pathology, San Antonio Military Medical Center, Fort Sam Houston, TX;
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Saenger
authors.affiliation: 7. Director, Cancer Vaccine Development Program, San Antonio, TX, USA.
authors.forename: George E
authors.initials: GE
authors.lastname: Peoples
keywords: Columnar Cell Change with atypia; Columnar Cell Hyperplasia with Atypia.; DIN 1A; Ductal Intraepithelial Neoplasia; Pure FEA; Pure Flat Epithelial Atypia