Pure flat epithelial atypia: is there a place for routine surgery?

Area of Science:

• Breast pathology
• Surgical oncology
• Radiology

Background:

• Flat epithelial atypia (FEA) and pure flat epithelial atypia (pFEA) are findings on breast biopsies.
• The management of these findings, particularly whether surgical excision is always necessary, is a clinical question.

Purpose of the Study:

• To evaluate the necessity of routine surgical excision for flat epithelial atypia (FEA) or pure flat epithelial atypia (pFEA) identified via large-core biopsy.

Main Methods:

• A retrospective review of 1678 large-core biopsies performed between 2005 and 2010.
• Identification of 136 FEA sites, with 63 classified as pFEA in 59 patients.
• Analysis of 52 surgical excisions performed on pFEA sites.

Main Results:

• Surgical excision of pFEA revealed 38% benign lesions, 56% borderline lesions, and 6% ductal carcinoma in situ.
• The rate of histologic underestimation was 3.8%.
• Underestimation occurred in two cases in patients with increased breast cancer risk.

Conclusions:

• For patients without a personal or family history of breast cancer, and with complete radiological excision of the lesion (excluding BI-RADS 5), annual monitoring may be a viable alternative to surgery.
• This approach is supported by the absence of underestimation in the studied low-risk cohort.