Erin Irene Neuschler MD, Presenter: Nothing to Disclose

Debra E. Kanter MD, Abstract Co-Author: Nothing to Disclose

Ellen Bachman Mendelson MD, Abstract Co-Author: Scientific Advisory Board, Hologic, Inc Research support, Siemens AG Speakers Bureau, Siemens AG Medical Advisory Board, Quantason, LLC Consultant, Quantason, LLC Speakers Bureau, SuperSonic Imagine Research support, SuperSonic Imagine Medical Advisory Board, Toshiba Corporation

Jessica Charlotte Jellins, Abstract Co-Author: Nothing to Disclose

Megan Sullivan, Abstract Co-Author: Nothing to Disclose

Paula M. Grabler MD, Abstract Co-Author: Nothing to Disclose

Alyssa Volk MD, Abstract Co-Author: Nothing to Disclose

Emily R Sosnoski MD, Abstract Co-Author: Nothing to Disclose

The need for surgical excision of flat epithelial atypia (FEA), a low grade cytologic atypia commonly found in stereotactic core biopsies of calcifications, is controversial.  Our aim was to determine our upgrade rate of FEA and if the radiologic appearance, association with other atypical lesions and patient clinical history can help us to identify criteria for excision.

An IRB approved retrospective review of stereotactic biopsies performed for calcifications with pathology of FEA was performed.  The study included 123 patients whose imaging and diagnoses were performed at our institution between 9/1/2007 and 10/26/2010.  Two breast imagers reviewed the mammograms and reassessed the calcifications prompting biopsy. The patients were grouped based on core biopsy pathology as having FEA alone (57 patients), FEA with ADH (53) or FEA with other atypical lesions (13) including atypical lobular hyperplasia, lobular carcinoma in situ, intraductal papilloma with atypia, and radial scar.  Excisional pathology was analyzed to determine the upgrade rate.    

17/123 (14%) patients did not undergo excision.  49/57 (86%) patients with FEA alone underwent excision, with only one pathology upgrade of invasive lobular carcinoma, for an upgrade rate of 1/49 (2%).  Of the patients with FEA and ADH, 45/53 (85%) went to excision and 6/45 (13%) had upgraded pathology, all to DCIS. 12/13 (92%) patients with FEA and other atypia went to excision, with no cases upgraded (0%).  

Our low upgrade rate to DCIS or invasive carcinoma, of 2%, of FEA in core biopsy specimens suggests that if FEA alone is found on a stereotactic biopsy of calcifications, then it may not need to be excised.

A low upgrade rate from FEA on core biopsy to malignancy on excision may influence clinical management. Surgical excision may not be indicated if FEA alone is found on core needle biopsy.

Neuschler, E, Kanter, D, Mendelson, E, Jellins, J, Sullivan, M, Grabler, P, Volk, A, Sosnoski, E, Flat Epithelial Atypia Diagnosed on Stereotactic Core Needle Biopsy of Calcifications: Indications for Surgical Excision.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11011857.html