Laura Jean Horvath MD, Presenter: Nothing to Disclose

Tiffani Milless MD, Abstract Co-Author: Nothing to Disclose

Madhavi Raghu MD, Abstract Co-Author: Nothing to Disclose

Veerle Bossuyt MD, Abstract Co-Author: Nothing to Disclose

Liane Elizabeth Philpotts MD, Abstract Co-Author: Nothing to Disclose

To review the outcome of concordant flat epithelial atypia (FEA) cases that were followed, rather than excised, after diagnosis by image guided needle biopsy of the breast.

A retrospective search of breast pathology and imaging records from July 2003 through March 2010 yielded 371 needle biopsy sites with a diagnosis of FEA as the highest-grade lesion in 357 patients: 268 stereotactic (243 for calcifications, 13 masses, 12 asymmetries), 71 MRI (55 non-mass, 16 mass enhancement), and 32 ultrasound (all masses). Follow-up records, available for 307 sites (83%), were reviewed for interval biopsy or diagnosis of breast cancer, and proximity of the original FEA biopsy site to any new cancer. Excluded from the final analysis were 40 FEA sites that underwent immediate excision for a variety of reasons including 16 discordant, with one discordant upgrade to DCIS grade 2 and one prophylactic mastectomy revealing a less than 1 mm lobular carcinoma.

267 FEA sites in 255 patients were concordant and followed for an average of 2.6 years. 16/267 (6%) underwent subsequent biopsy of the FEA site (6/16) or the FEA quadrant (10/16) for new or increasing calcifications (8/16), non-mass enhancement (4/16), mass (3/16), and asymmetry (1/16). Ipsilateral cancer was identified in proximity to the original FEA in 5/267 (1.9%) between 0.6 and 4.8 years: 3 at the FEA site (new non-mass enhancement at a prior site of calcifications, new calcifications at a prior site of non-mass enhancement, and increasing calcifications), and 2 in the FEA quadrant (new mass near a prior site of calcifications, and new calcifications near a prior asymmetry). These 5 cancers included one IDC/DCIS grade 3, one IDC/DCIS grade 2, and three DCIS grade 2. In comparison, subsequent contralateral cancer was identified in 4/255 patients (1.6%) between 0.7 and 3.6 years.

Less than 2% of the followed, concordant, FEA sites developed nearby ipsilateral breast cancer, a number not clinically significantly different than the incidence of contralateral cancer for these same patients.

Follow-up of concordant FEA may be an acceptable alternative to immediate excision, thereby decreasing the number of unnecessary surgical procedures.

Horvath, L, Milless, T, Raghu, M, Bossuyt, V, Philpotts, L, Flat Epithelial Atypia on Breast Needle Biopsy: Can Follow-up, Rather than Excision, Be Considered Appropriate Management?.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11002405.html