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Rates of upgrade to malignancy for 271 cases of flat epithelial atypia (FEA) diagnosed by breast core biopsy

Breast Cancer Research and Treatment volume 133, pages 659–666 (2012)Cite this article

Abstract

Flat epithelial atypia (FEA) is a borderline lesion that might represent an early stage in the development of certain low-grade carcinomas in situ and invasive cancers. There are no guidelines on its management. Our objectives were to determine the upgrade to malignancy rate and identify a subpopulation of patients that might undergo just mammographic surveillance. We retrospectively reviewed the data for 271 FEA cases among 5,555 breast core biopsies obtained over a 7-year period (January 2003–2010). We collated clinical data (age, history of cancer, menopausal status), radiological data (lesion type, size, Bi-Rads category), technical data (number of biopsies, needle gauge, excision quality) and histological data and sought correlations between these factors and upgrade rate. The 271 FEA comprised 128 cases of pure FEA, 135 cases of FEA + atypical ductal hyperplasia, and 8 cases of FEA + atypical lobular hyperplasia. Overall, 184 patients underwent surgery and 46 mammographic surveillance. Surgery detected 34 cases of malignancy (23 CIS, 7 invasive cancers, and 4 mixed cases) giving a 15% upgrade rate. Quality of excision was the only factor associated with under-diagnosis. The presence of FEA at biopsy warrants surgery.

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Acknowledgments

I would like to Thank Alain Toledano M.D and Jean-Philippe Brouland, for their valuable assistance for the realization of this article.

Conflict of interest

The authors declare that they have no conflict of interest.

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Affiliations

  1. Department of Surgery, Institut Curie-René Huguenin Hospital, Saint Cloud, France

    Alexandre Peres & Alain Boudinet

  2. Service de Gynécologie-Obstétrique, Hôpital Lariboisière AP-HP, Université Paris-Diderot, 2 rue Ambroise Paré, 75010, Paris, France

    Alexandre Peres & Emmanuel Barranger

  3. Department of Pathology, Institut Curie-René Huguenin Hospital, Saint Cloud, France

    Véronique Becette & Jean-Marc Guinebretiere

  4. Department of Radiodiagnosis, Institut Curie-René Huguenin Hospital, Saint Cloud, France

    Pascal Cherel

Authors
  1. Alexandre Peres
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  2. Emmanuel Barranger
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  3. Véronique Becette
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  4. Alain Boudinet
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Correspondence to Alexandre Peres.

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Peres, A., Barranger, E., Becette, V. et al. Rates of upgrade to malignancy for 271 cases of flat epithelial atypia (FEA) diagnosed by breast core biopsy. Breast Cancer Res Treat 133, 659–666 (2012). https://doi.org/10.1007/s10549-011-1839-x

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  • DOI: https://doi.org/10.1007/s10549-011-1839-x

Keywords

  • Breast
  • Vacuum-assisted core biopsy
  • Flat epithelial atypia
  • Upgrade