Nuha Abdullah Khoumais MBBS, Presenter: Nothing to Disclose

Anabel Medeiros Scaranelo MD, PhD, Abstract Co-Author: Nothing to Disclose

Susan J Done, Abstract Co-Author: Nothing to Disclose

Supriya Ravindra Kulkarni MD, Abstract Co-Author: Nothing to Disclose

Naomi Miller MD, Abstract Co-Author: Nothing to Disclose

Pavel Crystal MD, Abstract Co-Author: Nothing to Disclose

Hadas Moshonov, Abstract Co-Author: Nothing to Disclose

David R. McCready MD, Abstract Co-Author: Nothing to Disclose

Clinical significance of flat epithelial atypia (FEA) diagnosed at percutaneous breast biopsy remains controversial. The purpose of this study was to determine the upgrade rate of pure FEA diagnosed at core needle breast biopsy (CNB).

Retrospective review of 8996 imaging-guided CNB performed between 2002-2010 retrieved 119 cases (1.32%) of FEA, where 115 cases (1.27%) of pFEA (FEA not associated with other atypia) in 114 women (mean age 51 years, range 35-77 years). 11 patients were excluded due to a history of previous breast cancer or radiation therapy. Stereotactic CNB was performed in 77% (79 out of 103) cases with retrieval of calcifications in all cases. US-guided CNB was performed in 24% (25 of 103) cases. 93 lesions were surgically excised. 9 patients (10 lesions) without surgical excision had a 30 months mean time imaging follow-up. The upgraded rate of pFEA was defined as the number of patients who received the diagnosis of invasive or in situ carcinoma (DCIS) after surgical excision divided by the total number of patients.

Of 103 patients, 10 (9.7%) patients were diagnosed with a breast carcinoma: 9 as calcifications, one mass lesion. The size of calcifications was not found statistically different among benign or malignant pFEA (p<0.05). From 25 cases with US-guided CNB, one case (23 mm hypoechoic ill-defined mass) was found as DCIS. 5 of 10 (50%) upgraded cases were DCIS, 2 of 10 (20%) were invasive ductal carcinoma (IDC) presented as segmental pleomorphic calcifcations, range 40 - 54 mm, 2 of 10 (20%) invasive lobular carcinoma (ILC), 8 mm amorphous and 13 mm fine pleomorphic calcifications; and 1 case (10%) an invasive cancer with tubular subtype presented as 7 mm amorphous calcifications. Atypical ductal hyperplasia (ADH) was diagnosed in 20 of 93 (21.5%) surgical cases. All presented as calcifications, 45% coarse heterogenous with a mean size of 9.2 mm, range 5 to 17 mm. The surgical diagnosis of pFEA (39.8%) was found in 37 patients, 5 patients with ALH (5.4%) and 2 with LCIS (2.1%).

The upgraded rate of pFEA on CNB to cancer was 9.7%. The presence of 4.85% of invasive cancers found is substantial and warrants continuing management with surgical excision in all cases.

The prevalence of pFEA is low (1.27%) in 8996 CNB, however the 4.85% diagnosis of invasive cancer was found more related to fine pleomorphic and branching calcifications

Khoumais, N, Scaranelo, A, Done, S, Kulkarni, S, Miller, N, Crystal, P, Moshonov, H, McCready, D, Incidence of Malignancy or High-Risk Lesions in Pure Flat Epithelial Atypia Diagnosed at Breast Core Needle Biopsy.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11016771.html