Abstract
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.
Conclusion
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.
Similar content being viewed by others
References
Ellis IO, Humphreys S, Michell M, Pinder SE, Wells CA, Zakhour HD. Best Practice No 179. Guidelines for breast needle core biopsy handling and reporting in breast screening assessment. J Clin Pathol. 2004;57:897–902.
Maeda I, Okanami Y, Takagi M. Accuracy in percutaneous needle biopsy of the breast. Jpn J Breast Cancer. 2011;26:175–81.
Yamaguchi R, Tanaka M, Tse GM, Yamaguchi M, Terasaki H, Akiba J, et al. Pure flat epithelial atypia is uncommon in subsequent breast excisions for atypical epithelial proliferation. Cancer Sci. 2012;103:1580–5.
Hanby AM, Ellis IO, Schnitt SJ. WHO Classification of Tumours of the Breast. Columnar cell lesions. In: Lakhani SR, et al (eds) 2012: International Agency for Reseach on Cancer (IARC) 69372 Lyon Cedex 08, France.
Schnitt SJ, Collins L, Lakhani SR. WHO Classification of Tumours of the Breast. Flat epithelial atypia. In: Lakhani SR, et al (ed) 2012: International Agency for Reseach on Cancer (IARC) 69372 Lyon Cedex 08, France.
Verschuur-Maes AH, Witkamp AJ, de Bruin PC, van der Wall E, van Diest PJ. Progression risk of columnar cell lesions of the breast diagnosed in core needle biopsies. Int J Cancer. 2011;129:2674–80.
Maeda I, Oana Y, Okanami Y, Ariizumi Y, Koizumi H, Shimo A, et al. Flat Type DCIS of the breast initially diagnosed as flat epithelial atypia by percutaneous needle biopsy—a case report. St. Marian Med J. 2013;41:211–6.
Lavoue V, Roger CM, Poilblanc M, Proust N, Monghal-Verge C, Sagan C, et al. Pure flat epithelial atypia (DIN 1a) on core needle biopsy: study of 60 biopsies with follow-up surgical excision. Breast Cancer Res Treat. 2011;125:121–6.
Piubello Q, Parisi A, Eccher A, Barbazeni G, Franchini Z, Iannucci A. Flat epithelial atypia on core needle biopsy: which is the right management? Am J Surg Pathol. 2009;33:1078–84.
David N, Labbe-Devilliers C, Moreau D, Loussouarn D, Campion L. Diagnosis of flat epithelial atypia (FEA) after stereotactic vacuum-assisted biopsy (VAB) of the breast: what is the best management: systematic surgery for all or follow-up? J Radiol. 2006;87:1671–7.
Martel M, Barron-Rodriguez P, Tolgay Ocal I, Tolgay Ocal I, Dotto J, Tavassoli FA. Flat DIN 1 (flat epithelial atypia) on core needle biopsy: 63 cases identified retrospectively among 1,751 core biopsies performed over an 8-year period (1992-1999). Virchows Arch. 2007;451:883–91.
Rajan S, Sharma N, Dall BJ, Shaaban AM. What is the significance of flat epithelial atypia and what are the management implications? J Clin Pathol. 2011;64:1001–4.
Uzoaru I, Morgan BR, Liu ZG, Bellafiore FJ, Gaudier FS, Lo JV, et al. Flat epithelial atypia with and without atypical ductal hyperplasia: to re-excise or not. Results of a 5-year prospective study. Virchows Arch. 2012;461:419–23.
Peres A, Barranger E, Becette V, Boudinet A, Guinebretiere JM, Cherel P. Rates of upgrade to malignancy for 271 cases of flat epithelial atypia (FEA) diagnosed by breast core biopsy. Breast Cancer Res Treat. 2012;133:659–66.
Solorzano S, Mesurolle B, Omeroglu A, El Khoury M, Kao E, Aldis A, et al. Flat epithelial atypia of the breast: pathological-radiological correlation. AJR Am J Roentgenol. 2011;197:740–6.
Biggar MA, Kerr KM, Erzetich LM, Bennett IC. Columnar cell change with atypia (flat epithelial atypia) on breast core biopsy-outcomes following open excision. Breast J. 2012;18:578–81.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Maeda, I., Kanemaki, Y., Tozaki, M. et al. Positive predictive value for malignancy of pure flat epithelial atypia diagnosis by percutaneous needle biopsy of the breast: management of FEA in ultrasonography. Breast Cancer 22, 634–640 (2015). https://doi.org/10.1007/s12282-014-0530-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12282-014-0530-6