Advertisement

Breast Cancer Research and Treatment

, Volume 125, Issue 1, pp 121–126 | Cite as

Pure flat epithelial atypia (DIN 1a) on core needle biopsy: study of 60 biopsies with follow-up surgical excision

  • Vincent Lavoué
  • Claire Marie Roger
  • Mathieu Poilblanc
  • Nicolas Proust
  • Camille Monghal-Verge
  • Christine Sagan
  • Patrick Tas
  • Habiba Mesbah
  • Philippe Porée
  • Catherine Gay
  • Gilles Body
  • Jean Levêque
Clinical trial

Abstract

Flat epithelial atypia (FEA) is recognized as a precursor of breast cancer and its management (surgical excision or intensive follow-up) remains unclear after diagnosis on core needle biopsy (CNB). The aim of this study was to determine the underestimation rate of pure FEA on CNB and clinical, radiological, and pathological factors of underestimation. 4,062 CNBs from 5 breast cancer centers, performed over a 5-year period, were evaluated. A CNB diagnosis of pure FEA was made in 60 cases (1.5%) (the presence of atypical ductal hyperplasia, lobular neoplasia, radial scars, phyllodes tumor, papillary lesions, ductal carcinoma in situ or invasive carcinoma at CNB were exclusion criteria), and subsequent surgical excision was systematically performed. The histological diagnosis was retrospectively reviewed using standardized criteria and the precise terminology of the World Health Organization by two pathologist physicians. At surgical excision, 6 (10%) ductal carcinoma in situ and 2 (3%) invasive carcinoma were diagnosed. The total underestimation rate was 13%. FEA was associated with atypical ductal hyperplasia in 10 (17%) cases and with lobular neoplasia in 2 (3%) at final pathology. Residual FEA was found in 14 (23%) cases. No clinical, radiological or pathological factors were significantly associated with underestimation. Our data highlight the importance of recognizing and diagnosing FEA in core needle biopsies. Thus, the presence of FEA on CNB, even in isolation, warrants follow-up excision.

Keywords

Breast cancer Core needle biopsy Flat epithelial atypia Surgical excision 

Notes

Acknowledgments

The authors thank Mrs. Tracey Westcott for her assistance in revising the manuscript.

Conflict of interest

The authors declare no conflict of interest.

References

  1. 1.
    De Mascarel I, MacGrogan G (2007) Prise en charge des atypies épithéliales du sein. Ann Pathol 27(3):182–194CrossRefPubMedGoogle Scholar
  2. 2.
    Dupont WD, Page DL (1985) Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med 312(3):146–151CrossRefPubMedGoogle Scholar
  3. 3.
    Tavassoli FA, Millis RR, Boecker W, Lakhani SR (2003) Lobular neoplasia. In: Tavassoli FA, Devilee P (eds) Tumors of the breast and female genital organs. World Health Organization Classification of tumours. IARC press, Lyon, pp 60–64Google Scholar
  4. 4.
    Guerra-Wallace MM, Christensen WN, White RL Jr (2004) A retrospective study of columnar alteration with prominent apical snouts and secretions and the association with cancer. Am J Surg 188(4):395–398CrossRefPubMedGoogle Scholar
  5. 5.
    Goldstein NS, O’Malley BA (1997) Cancerization of small ectatic ducts of the breast by ductal carcinoma in situ cells with apocrine snouts: a lesion associated with tubular carcinoma. Am J Clin Pathol 107(5):561–566PubMedGoogle Scholar
  6. 6.
    Fraser JL, Raza S, Chorny K et al (1998) Columnar alteration with prominent apical snouts and secretions: a spectrum of changes frequently present in breast biopsies performed for microcalcifications. Am J Surg Pathol 22(12):1521–1527CrossRefPubMedGoogle Scholar
  7. 7.
    Oyama T, Iijima K, Takei H et al (2000) Atypical cystic lobule of the breast: an early stage of low-grade ductal carcinoma in situ. Breast Cancer 7(4):326–331CrossRefPubMedGoogle Scholar
  8. 8.
    Tavassoli FA (1998) Ductal carcinoma in situ: introduction of the concept of ductal intraepithelial neoplasia. Mod Pathol 11(2):140–154PubMedGoogle Scholar
  9. 9.
    Abdel-Fatah TM, Powe DG, Hodi Z et al (2008) Morphologic and molecular evolutionary pathways of low nuclear grade invasive breast cancers and their putative precursor lesions: further evidence to support the concept of low nuclear grade breast neoplasia family. Am J Surg Pathol 32(4):513–523CrossRefPubMedGoogle Scholar
  10. 10.
    Moinfar F, Man YG, Bratthauer GL et al (2000) Genetic abnormalities in mammary ductal intraepithelial neoplasia-flat type (“clinging ductal carcinoma in situ”): a simulator of normal mammary epithelium. Cancer 88(9):2072–2081CrossRefPubMedGoogle Scholar
  11. 11.
    Reis-Filho JS, Simpson PT, Jones C et al (2005) Pleomorphic lobular carcinoma of the breast: role of comprehensive molecular pathology in characterization of an entity. J Pathol 207(1):1–13CrossRefPubMedGoogle Scholar
  12. 12.
    Schnitt SJ (2003) The diagnosis and management of pre-invasive breast disease: flat epithelial atypia–classification, pathologic features and clinical significance. Breast Cancer Res 5(5):263–268CrossRefPubMedGoogle Scholar
  13. 13.
    Eby PR, Ochsner JE, DeMartini WB et al (2008) Is surgical excision necessary for focal atypical ductal hyperplasia found at stereotactic vacuum-assisted breast biopsy? Ann Surg Oncol 15(11):3232–3238CrossRefPubMedGoogle Scholar
  14. 14.
    Lavoue V, Graesslin O, Classe JM et al (2007) Management of lobular neoplasia diagnosed by core needle biopsy: study of 52 biopsies with follow-up surgical excision. Breast 16(5):533–539CrossRefPubMedGoogle Scholar
  15. 15.
    Piubello Q, Parisi A, Eccher A et al (2009) Flat epithelial atypia on core needle biopsy: which is the right management? Am J Surg Pathol 33:1078–1084CrossRefPubMedGoogle Scholar
  16. 16.
    Kunju LP, Kleer CG (2007) Significance of flat epithelial atypia on mammotome core needle biopsy: should it be excised? Hum Pathol 38(1):35–41CrossRefPubMedGoogle Scholar
  17. 17.
    Bonnett M, Wallis T, Rossmann M et al (2003) Histopathologic analysis of atypical lesions in image-guided core breast biopsies. Mod Pathol 16(2):154–160CrossRefPubMedGoogle Scholar
  18. 18.
    Nasser S, Fan M (2003) Does atypical columnar cell hyperplasia on breast core biopsy warrant follow up excision? (Abstract). Mod Pathol 15:36AGoogle Scholar
  19. 19.
    Brogi E, Tan L (2002) Findings at excisional biopsy (EBX) performed after identification of columnar cell change (CCC) of ductal epithelium in breast core biopsy (CBX) (Abstract). Mod Pathol 15(15):29A–30AGoogle Scholar
  20. 20.
    Noske A, Pahl S, Fallenberg E et al (2009) Flat epithelial atypia is a common subtype of B3 breast lesions and associated with noninvasive cancer but not with invasive cancer in final excision histology. Hum Pathol 41:522–527CrossRefPubMedGoogle Scholar
  21. 21.
    Noske A, Pahl S, Fallenberg E et al (2010) Flat epithelial atypia is a common subtype of B3 breast lesions and is associated with noninvasive cancer but not with invasive cancer in final excision histology. Hum Pathol 41(4):522–527CrossRefPubMedGoogle Scholar
  22. 22.
    American College of Radiology (1995) Breast imaging reporting and data system (BI-RADS) 2nd ed. Reston, VA: American College of RadiologyGoogle Scholar
  23. 23.
    Martel M, Barron-Rodriguez P, Tolgay Ocal I et al (2007) 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 451(5):883–891CrossRefPubMedGoogle Scholar
  24. 24.
    Bratthauer GL, Tavassoli FA (2004) Assessment of lesions coexisting with various grades of ductal intraepithelial neoplasia of the breast. Virchows Arch 444(4):340–344CrossRefPubMedGoogle Scholar
  25. 25.
    Boulos FI, Dupont WD, Simpson JF et al (2008) Histologic associations and long-term cancer risk in columnar cell lesions of the breast: a retrospective cohort and a nested case-control study. Cancer 113(9):2415–2421CrossRefPubMedGoogle Scholar
  26. 26.
    Tan PH, Ho BC, Selvarajan S et al (2005) Pathological diagnosis of columnar cell lesions of the breast: are there issues of reproducibility? J Clin Pathol 58(7):705–709CrossRefPubMedGoogle Scholar
  27. 27.
    O’Malley FP, Mohsin SK, Badve S et al (2006) Interobserver reproducibility in the diagnosis of flat epithelial atypia of the breast. Mod Pathol 19(2):172–179CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Vincent Lavoué
    • 1
    • 2
  • Claire Marie Roger
    • 1
    • 2
  • Mathieu Poilblanc
    • 3
    • 4
  • Nicolas Proust
    • 4
  • Camille Monghal-Verge
    • 5
  • Christine Sagan
    • 6
  • Patrick Tas
    • 1
  • Habiba Mesbah
    • 1
  • Philippe Porée
    • 1
  • Catherine Gay
    • 7
  • Gilles Body
    • 3
  • Jean Levêque
    • 1
    • 2
  1. 1.Eugène Marquis Comprehensive Cancer CenterRennesFrance
  2. 2.Department of GynecologyService de Gynécologie CHU Anne de BretagneRennes Cedex 2France
  3. 3.Department of GynecologyCHUAngersFrance
  4. 4.René Gauducheau Comprehensive Cancer CenterNantesFrance
  5. 5.Department of GynecologyOlympe de Gouges, CHU BretonneauToursFrance
  6. 6.Department of PathologyCHUNantesFrance
  7. 7.Department of GynecologyCHBelfortFrance

Personalised recommendations