title: Is the outcome at surgery different when flat epithelial atypia and lobular neoplasia are found in association at biopsy?
abstract: OBJECTIVE
  To assess the impact on the final outcome at surgery of flat epithelial atypia (FEA) when found concomitantly with lobular neoplasia (LN) in biopsy specimens compared with pure biopsy-proven FEA.
  
  
  METHODS
  The approval from the institutional review board of the CHUM (Centre Hospitalier Universitaire de Montréal) was obtained. A retrospective review of our database between 2009 and 2013 identified 81 females (mean age 54 years, range 38-90 years) with 81 FEA biopsy-proven lesions. These were pure or associated with LN only in 59/81 (73%) and 22/81 (27%) cases, respectively. Overall, 57/81 (70%) patients underwent surgery and 24/81 (30%) patients underwent mammographic surveillance with a mean follow-up of 36 months.
  
  
  RESULTS
  FEA presented more often as microcalcifications in 68/81 (84%) patients and were mostly amorphous in 49/68 (72%). After excluding radio pathologically discordant cases, pure FEA proved to be malignant at surgery in 1/41 (2%; 95% confidence interval 0.06-12.9). There was no statistically significant difference in the upgrade to malignancy whether FEA lesions were pure or associated to LN at biopsy (p = 0.4245); however, when paired in biopsy specimens, these lesions were more frequently associated with atypical ductal hyperplasia (ADH) at surgery than with pure FEA (p = 0.012).
  
  
  CONCLUSIONS
  Our results show a 2% upgrade rate to malignancy of pure FEA lesions. When FEA is found in association with LN at biopsy, surgical excision yields more frequently ADH than pure FEA thus warranting close surveillance or even surgical excision. Advances in knowledge: The association of LN with FEA at biopsy was more frequently associated with ADH at surgery than with pure FEA. If a biopsy-proven FEA lesion is deemed concordant with the imaging finding, when paired with LN at biopsy, careful surveillance or even surgical excision is suggested.
authors.affiliation: 1 Department of Radiology, Breast Centre, Centre Hospitalier Universitaire de Montréal, Montreal, QC, Canada.
authors.forename: Mona
authors.initials: M
authors.lastname: El Khoury
authors.affiliation: 2 Department of Pathology, Centre Hospitalier Universitaire de Montréal, Montreal, QC, Canada.
authors.forename: Lilia Maria
authors.initials: LM
authors.lastname: Sanchez
authors.affiliation: 1 Department of Radiology, Breast Centre, Centre Hospitalier Universitaire de Montréal, Montreal, QC, Canada.
authors.forename: Lucie
authors.initials: L
authors.lastname: Lalonde
authors.affiliation: 1 Department of Radiology, Breast Centre, Centre Hospitalier Universitaire de Montréal, Montreal, QC, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Trop
authors.affiliation: 1 Department of Radiology, Breast Centre, Centre Hospitalier Universitaire de Montréal, Montreal, QC, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: David
authors.affiliation: 3 Department of Radiology, Cedar Breast Centre, McGill University Health Center, Montreal, QC, Canada.
authors.forename: Benoît
authors.initials: B
authors.lastname: Mesurolle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001940:Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000071960:Breast Carcinoma In Situ / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D042361:Mammary Glands, Human / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome