Overview of Pathology Evaluation of Breast Lesions and Quality Assurance

  • Michael O. Idowu
  • Jaime A. Singh
  • Margaret M. Grimes
Chapter

Abstract

Pathologic evaluation of breast core needle biopsies or surgical specimens is an integral part of management of breast lesions. Suboptimal evaluation may have significant impact on patient care. It is critical for pathologic findings to provide satisfactory explanation for the breast imaging findings for optimal patient care. Awareness of the implications of pathologic diagnoses to patients in terms of “what next” should inform the approach to interpretation of breast lesions. The chapter discussed relevant points in terms of what happens before and after pathologic evaluation. Diagnostic criteria, challenges and pitfalls in the interpretation of fibroepithelial lesions, papillary neoplasms, invasive carcinomas and selective proliferative and non-proliferative breast lesions are highlighted.

References

  1. 1.
    Steinberg JL, Trudeau ME, Ryder DE, Fishell E, Chapman JA, McCready DR, et al. Combined fine-needle aspiration, physical examination and mammography in the diagnosis of palpable breast masses: their relation to outcome for women with primary breast cancer. Can J Surg. 1996;39(4):302–11.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Morris A, Pommier RF, Schmidt WA, Shih RL, Alexander PW, Vetto JT. Accurate evaluation of palpable breast masses by the triple test score. Arch Surg. 1998;133(9):930–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Kaufman Z, Shpitz B, Shapiro M, Rona R, Lew S, Dinbar A. Triple approach in the diagnosis of dominant breast masses: combined physical examination, mammography, and fine-needle aspiration. J Surg Oncol. 1994;56(4):254–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Kocjan G, Bourgain C, Fassina A, Hagmar B, Herbert A, Kapila K, et al. The role of breast FNAC in diagnosis and clinical management: a survey of current practice. Cytopathology. 2008;19(5):271–8.CrossRefPubMedGoogle Scholar
  5. 5.
    WHO classification of tumours of the breast. 4th ed. Lyon: International Agency for Research on Cancer; 2012.Google Scholar
  6. 6.
    Idowu MO, Hardy LB, Souers RJ, Nakhleh RE. Pathologic diagnostic correlation with breast imaging findings: a College of American Pathologists Q-Probes study of 48 institutions. Arch Pathol Lab Med. 2012;136(1):53–60.CrossRefPubMedGoogle Scholar
  7. 7.
    Idowu MO, Wiles A, Wan W, Wilkinson DS, Powers CN. Equivocal or ambiguous terminologies in pathology: focus of continuous quality improvement? Am J Surg Pathol. 2013;37(11):1722–7.CrossRefPubMedGoogle Scholar
  8. 8.
    van Roozendaal LM, Goorts B, Klinkert M, Keymeulen KB, De Vries B, Strobbe LJ, et al. Sentinel lymph node biopsy can be omitted in DCIS patients treated with breast conserving therapy. Breast Cancer Res Treat. 2016;156(3):517–25.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Coromilas EJ, Wright JD, Huang Y, Feldman S, Neugut AI, Hillyer GC, et al. Axillary evaluation and lymphedema in women with ductal carcinoma in situ. Breast Cancer Res Treat. 2016;158(2):373–84.CrossRefPubMedGoogle Scholar
  10. 10.
    Dupont WD, Page DL, Parl FF, Vnencak-Jones CL, Plummer WD Jr, Rados MS, et al. Long-term risk of breast cancer in women with fibroadenoma. N Engl J Med. 1994;331(1):10–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Bandyopadhyay S, Barak S, Hayek K, Thomas S, Saeed H, Beydoun R, et al. Can problematic fibroepithelial lesions be accurately classified on core needle biopsies? Hum Pathol. 2016;47(1):38–44.CrossRefPubMedGoogle Scholar
  12. 12.
    Tsang AK, Chan SK, Lam CC, Lui PC, Chau HH, Tan PH, et al. Phyllodes tumours of the breast – differentiating features in core needle biopsy. Histopathology. 2011;59(4):600–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Lawton TJ, Acs G, Argani P, Farshid G, Gilcrease M, Goldstein N, et al. Interobserver variability by pathologists in the distinction between cellular fibroadenomas and phyllodes tumors. Int J Surg Pathol. 2014;22(8):695–8.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Jacobs TW, Chen YY, Guinee DG Jr, Holden JA, Cha I, Bauermeister DE, et al. Fibroepithelial lesions with cellular stroma on breast core needle biopsy: are there predictors of outcome on surgical excision? Am J Clin Pathol. 2005;124(3):342–54.CrossRefPubMedGoogle Scholar
  15. 15.
    Tan BY, Acs G, Apple SK, Badve S, Bleiweiss IJ, Brogi E, et al. Phyllodes tumours of the breast: a consensus review. Histopathology. 2016;68(1):5–21.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Jara-Lazaro AR, Akhilesh M, Thike AA, Lui PC, Tse GM, Tan PH. Predictors of phyllodes tumours on core biopsy specimens of fibroepithelial neoplasms. Histopathology. 2010;57(2):220–32.CrossRefPubMedGoogle Scholar
  17. 17.
    Giri D. Recurrent challenges in the evaluation of fibroepithelial lesions. Arch Pathol Lab Med. 2009;133(5):713–21.PubMedGoogle Scholar
  18. 18.
    Cowan ML, Argani P, Cimino-Mathews A. Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins. Mod Pathol. 2016;29(3):259–65.CrossRefPubMedGoogle Scholar
  19. 19.
    Grimes MM. Cystosarcoma phyllodes of the breast: histologic features, flow cytometric analysis, and clinical correlations. Mod Pathol. 1992;5(3):232–9.PubMedGoogle Scholar
  20. 20.
    Kanhai RC, Hage JJ, Bloemena E, van Diest PJ, Karim RB. Mammary fibroadenoma in a male-to-female transsexual. Histopathology. 1999;35(2):183–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Lemmo G, Garcea N, Corsello S, Tarquini E, Palladino T, Ardito G, et al. Breast fibroadenoma in a male-to-female transsexual patient after hormonal treatment. Eur J Surg Suppl. 2003;588:69–71.Google Scholar
  22. 22.
    Karihtala P, Rissanen T, Tuominen H. Male malignant phyllodes breast tumor after prophylactic breast radiotherapy and bicalutamide treatment: a case report. Anticancer Res. 2016;36(7):3433–6.PubMedGoogle Scholar
  23. 23.
    Agoumi M, Giambattista J, Hayes MM. Practical considerations in breast papillary lesions: a review of the literature. Arch Pathol Lab Med. 2016;140(8):770–90.CrossRefPubMedGoogle Scholar
  24. 24.
    Wei S. Papillary lesions of the breast: an update. Arch Pathol Lab Med. 2016;140(7):628–43.CrossRefPubMedGoogle Scholar
  25. 25.
    Collins LC, Schnitt SJ. Papillary lesions of the breast: selected diagnostic and management issues. Histopathology. 2008;52(1):20–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Ueng SH, Mezzetti T, Tavassoli FA. Papillary neoplasms of the breast: a review. Arch Pathol Lab Med. 2009;133(6):893–907.PubMedGoogle Scholar
  27. 27.
    Tan PH, Schnitt SJ, van de Vijver MJ, Ellis IO, Lakhani SR. Papillary and neuroendocrine breast lesions: the WHO stance. Histopathology. 2015;66(6):761–70.CrossRefPubMedGoogle Scholar
  28. 28.
    Page DL, Salhany KE, Jensen RA, Dupont WD. Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma. Cancer. 1996;78(2):258–66.CrossRefPubMedGoogle Scholar
  29. 29.
    Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med. 1985;312(3):146–51.CrossRefPubMedGoogle Scholar
  30. 30.
    Lewis JT, Hartmann LC, Vierkant RA, Maloney SD, Shane Pankratz V, Allers TM, et al. An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. Am J Surg Pathol. 2006;30(6):665–72.CrossRefPubMedGoogle Scholar
  31. 31.
    Page DL, Dupont WD. Benign breast disease: indicators of increased breast cancer risk. Cancer Detect Prev. 1992;16(2):93–7.PubMedGoogle Scholar
  32. 32.
    Jensen RA, Dupont WD, Page DL. Diagnostic criteria and cancer risk of proliferative breast lesions. J Cell Biochem Suppl. 1993;17G:59–64.CrossRefPubMedGoogle Scholar
  33. 33.
    Laval M, Delangle R, Ndoye A, Sylvestre E, Laviolle B, Lavoue V, et al. The role of percutaneous biopsy and prognostic factors of malignancy in solitary breast papilloma: a retrospective multicenter study of 259 cases. Anticancer Res. 2015;35(12):6881–6.PubMedGoogle Scholar
  34. 34.
    Wyss P, Varga Z, Rossle M, Rageth CJ. Papillary lesions of the breast: outcomes of 156 patients managed without excisional biopsy. Breast J. 2014;20(4):394–401.CrossRefPubMedGoogle Scholar
  35. 35.
    Yamaguchi R, Tanaka M, Tse GM, Yamaguchi M, Terasaki H, Hirai Y, et al. Management of breast papillary lesions diagnosed in ultrasound-guided vacuum-assisted and core needle biopsies. Histopathology. 2015;66(4):565–76.CrossRefPubMedGoogle Scholar
  36. 36.
    Shamonki J, Chung A, Huynh KT, Sim MS, Kinnaird M, Giuliano A. Management of papillary lesions of the breast: can larger core needle biopsy samples identify patients who may avoid surgical excision? Ann Surg Oncol. 2013;20(13):4137–44.CrossRefPubMedGoogle Scholar
  37. 37.
    Fu CY, Chen TW, Hong ZJ, Chan DC, Young CY, Chen CJ, et al. Papillary breast lesions diagnosed by core biopsy require complete excision. Eur J Surg Oncol. 2012;38(11):1029–35.CrossRefPubMedGoogle Scholar
  38. 38.
    Tseng HS, Chen YL, Chen ST, Wu YC, Kuo SJ, Chen LS, et al. The management of papillary lesion of the breast by core needle biopsy. Eur J Surg Oncol. 2009;35(1):21–4.CrossRefPubMedGoogle Scholar
  39. 39.
    McGhan LJ, Pockaj BA, Wasif N, Giurescu ME, McCullough AE, Gray RJ. Papillary lesions on core breast biopsy: excisional biopsy for all patients? Am Surg. 2013;79(12):1238–42.PubMedGoogle Scholar
  40. 40.
    Rakha EA, Gandhi N, Climent F, van Deurzen CH, Haider SA, Dunk L, et al. Encapsulated papillary carcinoma of the breast: an invasive tumor with excellent prognosis. Am J Surg Pathol. 2011;35(8):1093–103.CrossRefPubMedGoogle Scholar
  41. 41.
    Mulligan AM, O’Malley FP. Metastatic potential of encapsulated (intracystic) papillary carcinoma of the breast: a report of 2 cases with axillary lymph node micrometastases. Inter J Surg Pathol. 2007;15(2):143–7.CrossRefGoogle Scholar
  42. 42.
    Hayes MM. Adenomyoepithelioma of the breast: a review stressing its propensity for malignant transformation. J Clin Pathol. 2011;64(6):477–84.CrossRefPubMedGoogle Scholar
  43. 43.
    McLaren BK, Smith J, Schuyler PA, Dupont WD, Page DL. Adenomyoepithelioma: clinical, histologic, and immunohistologic evaluation of a series of related lesions. Am J Surg Pathol. 2005;29(10):1294–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Yoon JY, Chitale D. Adenomyoepithelioma of the breast: a brief diagnostic review. Arch Pathol Lab Med. 2013;137(5):725–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Wahner-Roedler DL, Sebo TJ, Gisvold JJ. Hamartomas of the breast: clinical, radiologic, and pathologic manifestations. Breast J. 2001;7(2):101–5.CrossRefPubMedGoogle Scholar
  46. 46.
    Magro G. Mammary myofibroblastoma: an update with emphasis on the most diagnostically challenging variants. Histol Histopathol. 2016;31(1):1–23.PubMedGoogle Scholar
  47. 47.
    Magro G. Mammary myofibroblastoma: a tumor with a wide morphologic spectrum. Arch Pathol Lab Med. 2008;132(11):1813–20.PubMedGoogle Scholar
  48. 48.
    Wellings SR, Jensen HM, Marcum RG. An atlas of subgross pathology of the human breast with special reference to possible precancerous lesions. J Natl Cancer Inst. 1975;55(2):231–73.PubMedGoogle Scholar
  49. 49.
    Williams AS, Hache KD. Recognition and discrimination of tissue-marking dye color by surgical pathologists: recommendations to avoid errors in margin assessment. Am J Clin Pathol. 2014;142(3):355–61.CrossRefPubMedGoogle Scholar
  50. 50.
    Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol. 2014;32(14):1507–15.CrossRefPubMedGoogle Scholar
  51. 51.
    Sigal-Zafrani B, Lewis JS, Clough KB, Vincent-Salomon A, Fourquet A, Meunier M, et al. Histological margin assessment for breast ductal carcinoma in situ: precision and implications. Mod Pathol. 2004;17(1):81–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Silverstein MJ, Lagios MD, Groshen S, Waisman JR, Lewinsky BS, Martino S, et al. The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med. 1999;340(19):1455–61.CrossRefPubMedGoogle Scholar
  53. 53.
    Dunne C, Burke JP, Morrow M, Kell MR. Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol. 2009;27(10):1615–20.CrossRefPubMedGoogle Scholar
  54. 54.
    Wright MJ, Park J, Fey JV, Park A, O’Neill A, Tan LK, et al. Perpendicular inked versus tangential shaved margins in breast-conserving surgery: does the method matter? J Am Coll Surg. 2007;204(4):541–9.CrossRefPubMedGoogle Scholar
  55. 55.
    Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Ann Surg Oncol. 2016;23(12):3801–10.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Weaver DL. Pathology evaluation of sentinel lymph nodes in breast cancer: protocol recommendations and rationale. Mod Pathol. 2010;23(Suppl 2):S26–32.CrossRefPubMedGoogle Scholar
  57. 57.
    Wolff AC, Hammond ME, Hicks DG, Dowsett M, McShane LM, Allison KH, et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. Arch Pathol Lab Med. 2014;138(2):241–56.CrossRefPubMedGoogle Scholar
  58. 58.
    Fitzgibbons PL, Murphy DA, Hammond ME, Allred DC, Valenstein PN. Recommendations for validating estrogen and progesterone receptor immunohistochemistry assays. Arch Pathol Lab Med. 2010;134(6):930–5.PubMedGoogle Scholar
  59. 59.
    Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version). Arch Pathol Lab Med. 2010;134(7):e48–72.PubMedGoogle Scholar
  60. 60.
    Bassett LW. Mammographic analysis of calcifications. Radiol Clin North Am. 1992;30(1):93–105.PubMedGoogle Scholar
  61. 61.
    Monsees BS. Evaluation of breast microcalcifications. Radiol Clin North Am. 1995;33(6):1109–21.PubMedGoogle Scholar
  62. 62.
    Lazarus E, Mainiero MB, Schepps B, Koelliker SL, Livingston LS. BI-RADS lexicon for US and mammography: interobserver variability and positive predictive value. Radiology. 2006;239(2):385–91.CrossRefPubMedGoogle Scholar
  63. 63.
    Gallagher R, Schafer G, Redick M, Inciradi M, Smith W, Fan F, et al. Microcalcifications of the breast: a mammographic-histologic correlation study using a newly designed path/rad tissue tray. Ann Diagn Pathol. 2012;16(3):196–201.CrossRefPubMedGoogle Scholar
  64. 64.
    Hofvind S, Iversen BF, Eriksen L, Styr BM, Kjellevold K, Kurz KD. Mammographic morphology and distribution of calcifications in ductal carcinoma in situ diagnosed in organized screening. Acta Radiol. 2011;52(5):481–7.CrossRefPubMedGoogle Scholar
  65. 65.
    Kopans D, Gavenonis S, Halpern E, Moore R. Calcifications in the breast and digital breast tomosynthesis. Breast J. 2011;17(6):638–44.CrossRefPubMedGoogle Scholar
  66. 66.
    Demetri-Lewis A, Slanetz PJ, Eisenberg RL. Breast calcifications: the focal group. AJR Am J Roentgenol. 2012;198(4):W325–43.CrossRefPubMedGoogle Scholar
  67. 67.
    Scimeca M, Giannini E, Antonacci C, Pistolese CA, Spagnoli LG, Bonanno E. Microcalcifications in breast cancer: an active phenomenon mediated by epithelial cells with mesenchymal characteristics. BMC Cancer. 2014;14:286.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Cox RF, Morgan MP. Microcalcifications in breast cancer: lessons from physiological mineralization. Bone. 2013;53(2):437–50.CrossRefPubMedGoogle Scholar
  69. 69.
    Morgan MP, Cooke MM, McCarthy GM. Microcalcifications associated with breast cancer: an epiphenomenon or biologically significant feature of selected tumors? J Mammary Gland Biol Neoplasia. 2005;10(2):181–7.CrossRefPubMedGoogle Scholar
  70. 70.
    Tse GM, Tan PH, Cheung HS, Chu WC, Lam WW. Intermediate to highly suspicious calcification in breast lesions: a radio-pathologic correlation. Breast Cancer Res Treat. 2008;110(1):1–7.CrossRefPubMedGoogle Scholar
  71. 71.
    Michaels AY, Birdwell RL, Chung CS, Frost EP, Giess CS. Assessment and management of challenging BI-RADS category 3 mammographic lesions. Radiographics. 2016;36(5):1261–72.CrossRefPubMedGoogle Scholar
  72. 72.
    Page DL, Dupont WD. Anatomic markers of human premalignancy and risk of breast cancer. Cancer. 1990;66(Suppl 6):1326–35.CrossRefPubMedGoogle Scholar
  73. 73.
    Dahlstrom JE, Sutton S, Jain S. Histologic-radiologic correlation of mammographically detected microcalcification in stereotactic core biopsies. Am J Surg Pathol. 1998;22(2):256–9.CrossRefPubMedGoogle Scholar
  74. 74.
    Dahlstrom JE, Jain S. Histological correlation of mammographically detected microcalcifications in stereotactic core biopsies. Pathology. 2001;33(4):444–8.CrossRefPubMedGoogle Scholar
  75. 75.
    Tse GM, Tan PH, Pang AL, Tang AP, Cheung HS. Calcification in breast lesions: pathologists’ perspective. J Clin Pathol. 2008;61(2):145–51.CrossRefPubMedGoogle Scholar
  76. 76.
    Bassett L, Winchester DP, Caplan RB, Dershaw DD, Dowlatshahi K, Evans WP 3rd, , et al. Stereotactic core-needle biopsy of the breast: a report of the Joint Task Force of the American College of Radiology, American College of Surgeons, and College of American Pathologists. CA Cancer J Clin 1997;47(3):171–190.CrossRefPubMedGoogle Scholar
  77. 77.
    Liberman L, Menell JH. Breast imaging reporting and data system (BI-RADS). Radiol Clin North Am. 2002;40(3):409–30, v.CrossRefPubMedGoogle Scholar
  78. 78.
    Margolin FR, Kaufman L, Jacobs RP, Denny SR, Schrumpf JD. Stereotactic core breast biopsy of malignant calcifications: diagnostic yield of cores with and cores without calcifications on specimen radiographs. Radiology. 2004;233(1):251–4.CrossRefPubMedGoogle Scholar
  79. 79.
    Easley S, Abdul-Karim FW, Klein N, Wang N. Segregation of radiographic calcifications in stereotactic core biopsies of breast: is it necessary? Breast J. 2007;13(5):486–9.CrossRefPubMedGoogle Scholar
  80. 80.
    Pisano ED, Zuley M, Baum JK, Marques HS. Issues to consider in converting to digital mammography. Radiol Clin North Am. 2007;45(5):813–30, vi.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Pagliari CM, Hoang T, Reddy M, Wilkinson LS, Poloniecki JD, Given-Wilson RM. Diagnostic quality of 50 and 100 mum computed radiography compared with screen-film mammography in operative breast specimens. Br J Radiol. 2012;85(1015):910–6.CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Tornos C, Silva E, el-Naggar A, Pritzker KP. Calcium oxalate crystals in breast biopsies. The missing microcalcifications. Am J Surg Pathol. 1990;14(10):961–8.CrossRefPubMedGoogle Scholar
  83. 83.
    Lai KC, Slanetz PJ, Eisenberg RL. Linear breast calcifications. AJR Am J Roentgenol. 2012;199(2):W151–7.CrossRefPubMedGoogle Scholar
  84. 84.
    Wells CA, El-Ayat GA. Non-operative breast pathology: apocrine lesions. J Clin Pathol. 2007;60(12):1313–20.CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Zagorianakou P, Zagorianakou N, Stefanou D, Makrydimas G, Agnantis NJ. The enigmatic nature of apocrine breast lesions. Virchows Arch. 2006;448(5):525–31.CrossRefPubMedGoogle Scholar
  86. 86.
    Grimes MM, Karageorge LS, Hogge JP. Does exhaustive search for microcalcifications improve diagnostic yield in stereotactic core needle breast biopsies? Mod Pathol. 2001;14(4):350–3.CrossRefPubMedGoogle Scholar
  87. 87.
    Dialani V, Venkataraman S, Frieling G, Schnitt SJ, Mehta TS. Does isolated flat epithelial atypia on vacuum-assisted breast core biopsy require surgical excision? Breast J. 2014;20(6):606–14.CrossRefPubMedGoogle Scholar
  88. 88.
    Calhoun BC, Sobel A, White RL, Gromet M, Flippo T, Sarantou T, et al. Management of flat epithelial atypia on breast core biopsy may be individualized based on correlation with imaging studies. Mod Pathol. 2015;28(5):670–6.CrossRefPubMedGoogle Scholar
  89. 89.
    Maeda I, Kanemaki Y, Tozaki M, Koizumi H, Oana Y, Okanami Y, 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. 2015;22(6):634–40.CrossRefPubMedGoogle Scholar
  90. 90.
    Said SM, Visscher DW, Nassar A, Frank RD, Vierkant RA, Frost MH, et al. Flat epithelial atypia and risk of breast cancer: a Mayo cohort study. Cancer. 2015;121(10):1548–55.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Michael O. Idowu
    • 1
  • Jaime A. Singh
    • 1
  • Margaret M. Grimes
    • 1
  1. 1.Department of PathologyVirginia Commonwealth University Health (VCU HEALTH)RichmondUSA

Personalised recommendations