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Morphological parameters of flat epithelial atypia (FEA) in stereotactic vacuum-assisted needle core biopsies do not predict the presence of malignancy on subsequent surgical excision

Virchows Archiv volume 461, pages 405–417 (2012)Cite this article

Abstract

Flat epithelial atypia (FEA) may represent the earliest precursor of low-grade breast cancer and often coexists with more advanced atypical proliferative breast lesions such as atypical ductal hyperplasia (ADH) and lobular intraepithelial neoplasia (LIN). The present study aims to investigate the association between morphological parameters of FEA and presence of malignancy at surgical excision (SE) and the clinical significance of the association of FEA with ADH and/or LIN. This study included 589 cases of stereotactic 11-gauge vacuum-assisted needle core biopsy (VANCB), reporting a diagnosis of FEA, ADH or LIN with subsequent SE from 14 pathology departments in Italy. Available slides were reviewed, with 114 (19.4 %) showing a malignant outcome at SE. Among the 190 cases of pure FEA, no statistically significant association emerged between clinical–pathological parameters of FEA and risk of malignancy. Logistic regression analyses showed an increased risk of malignancy according to the extension of ADH among the 275 cases of FEA associated with ADH (p = 0.004) and among the 34 cases of FEA associated with ADH and LIN (p = 0.02). In the whole series, a statistically significant increased malignancy risk emerged according to mammographic R1–R3/R4–R5 categories (OR = 1.56; p = 0.04), extension (OR = 1.24; p = 0.04) and grade (OR = 1.94; p = 0.004) of cytological atypia of FEA. The presence of ADH was associated with an increased malignancy risk (OR = 2.85; p < 0.0001). Our data confirm the frequent association of FEA with ADH and/or LIN. A diagnosis of pure FEA on VANCB carries a 9.5 % risk of concurrent malignancy and thus warrants follow-up excision because none of the clinical–pathological parameters predicts which cases will present carcinoma on SE.

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Acknowledgments

Pathologists contributing to VANCB Study Group: Antonacci CM (Milano), Bersiga A (Cremona), Bianchi S (Firenze), Carrillo G (Napoli), Castellano I (Torino), Cattani MG (Bologna), Dante S (Vicenza), Di Loreto C (Udine), Di Stefano D (Roma), Ferrero G (Cremona), Giardina C (Bari), Laurino L (Treviso), Piubello Q (Verona), Querzoli P (Ferrara), Renne G (Milano), Sapino A (Torino), Vezzosi V (Firenze). Radiologists contributing to VANCB Study Group: Amadori S (Milano), Ambrogetti D (Firenze), Balestrieri N (Treviso), Bazzocchi M (Udine), Bodini MT (Cremona), Cassano E (Milano), Durando M (Torino), Festa R (Napoli), Guerrieri AM (SARIS, Bari), Maggian P (Vicenza), Mariscotti G (Torino), Mattei M (Roma), Montemezzi S (Verona), Saguatti G (Bologna), Scalabrin U (Vicenza), Trasente I (Napoli), Ventrella V (Bari)

Funding source

This work was supported by a grant from the “Ente Cassa di Risparmio” of Florence-Italy.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Affiliations

  1. Division of Pathological Anatomy, Department of Medical and Surgical Critical Care, AOU Careggi, University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy

    Simonetta Bianchi

  2. Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy

    Benedetta Bendinelli & Domenico Palli

  3. Division of Pathological Anatomy, Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy

    Isabella Castellano

  4. Pathological Anatomy Unit, OCM, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy

    Quirino Piubello

  5. Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy

    Giuseppe Renne

  6. Pathological Anatomy Unit, Bellaria Hospital, Bologna, Italy

    Maria Grazia Cattani

  7. Division of Pathological Anatomy, Department of Neurological Sciences, St Andrea Hospital, “La Sapienza” University, Rome, Italy

    Domenica Di Stefano

  8. Pathological Anatomy Unit, AORN Cardarelli Hospital, Naples, Italy

    Giovanna Carrillo

  9. Pathological Anatomy Unit, General Hospital of Treviso, Treviso, Italy

    Licia Laurino

  10. Pathological Anatomy Unit, Istituti Ospitalieri di Cremona, Cremona, Italy

    Alessandra Bersiga

  11. Department of Pathological Anatomy, University of Bari, Bari, Italy

    Carmela Giardina

  12. Pathological Anatomy Unit, Hospital of Vicenza, Vicenza, Italy

    Stefania Dante

  13. Division of Pathological Anatomy, Department of Medical and Biological Sciences, University of Udine, Udine, Italy

    Carla Di Loreto

  14. Department of Pathology, National Cancer Institute Giovanni Paolo II, Bari, Italy

    Carmela Quero

  15. Pathological Anatomy Unit, Sacco Hospital, Milan, Italy

    Concetta Maria Antonacci

Authors
  1. Simonetta Bianchi
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  2. Benedetta Bendinelli
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  3. Isabella Castellano
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  6. Maria Grazia Cattani
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  7. Domenica Di Stefano
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  8. Giovanna Carrillo
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  9. Licia Laurino
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  10. Alessandra Bersiga
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  11. Carmela Giardina
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  12. Stefania Dante
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  13. Carla Di Loreto
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  14. Carmela Quero
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  15. Concetta Maria Antonacci
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  16. Domenico Palli
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VANCB Study Group

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Correspondence to Simonetta Bianchi.

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Bianchi, S., Bendinelli, B., Castellano, I. et al. Morphological parameters of flat epithelial atypia (FEA) in stereotactic vacuum-assisted needle core biopsies do not predict the presence of malignancy on subsequent surgical excision. Virchows Arch 461, 405–417 (2012). https://doi.org/10.1007/s00428-012-1279-y

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  • DOI: https://doi.org/10.1007/s00428-012-1279-y

Keywords

  • Breast
  • Flat epithelial atypia
  • Stereotactic vacuum-assisted needle core biopsy
  • Surgical excision
  • Malignancy