Veronica Girardi MD, Presenter: Nothing to Disclose

Mara Tonegutti, Abstract Co-Author: Nothing to Disclose

Franco Bonetti MD, Abstract Co-Author: Nothing to Disclose

To retrospectively determine the underestimation rate of flat epithelial atypia on stereotactic guided vacuum-assisted biopsy and clinical, radiological, and pathological factors of underestimation in asyntomatic patients.

Review of medical records of 986 SVAB over a 9 years period (02/02-02/11). All women had biopsies performed with a 11-gauge device. Women with FEA diagnosed at SVAB that underwent surgical excision or imaging follow up at least for 2 years comprised the study group (n=52). Columnar cell changes lesions were excluded. The histological diagnosis was retrospectively reviewed using standardized criteria and the precise terminology of the World Health Organization by one skilled pathologist physician. SVAB histology revealed pure FEA (n=32), FEA associated with other high risk lesions namely lobular neoplasia (LN, n=16), atypical ductal hyperplasia (ADH,n=3), other (n=1). All SVAB were considered technically successful.  

All cases were depicted as microcalcifications (isolated in 84.6% , multiple foci in 15.4%). The average size was 3-47 mm (median size 6 mm). Two women had previous high risk breast lesions diagnosis and other two had previous breast omolateral cancer (in different quadrant). Ten women declined excisional biopsy and were stable at clinical-mammographic follow-up (range follow-up: 2-8 years). Of 42 excised lesions, 4 lesions were upgraded to ductal carcinoma (3-DCIS, 1-IDC). The total underestimation rate was 7.8%. At excision, carcinoma was found in 3/32 (9.3%) of pure FEA and in 1/20 (5%) FEA associated with other high risk lesions (p=0.49). In the remaining cases, residual benign lesions foci (FEA, LN, ADH) was found in 22 cases and no residual disease in 7 cases (SVAB complete removal).

FEA commonly was encountered in the background of higher-grade lesions and it was upgraded on surgical excision in 7.8% of cases. Current management of FEA is best achieved through a multidisciplinary consensus. However our data highlight the importance of recognizing and diagnosing FEA at SVAB. Thus, the presence of FEA on SVAB, even in isolation, warrants surgical excision.

FEA is recognized as a precursor of breast cancer and its management (surgical excision or intensive follow-up) after diagnosis on SVAB remains unclear.

Girardi, V, Tonegutti, M, Bonetti, F, Uncommon High-Risk Lesions of the Breast Diagnosed at Stereotactic-guided Vacuum-assisted Biopsy (VAB): Incidence of Malignancy in Flat Epithelial Atypia (FEA).  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11011313.html