Flat epithelial atypia: are we being too aggressive?

Area of Science:

• Breast pathology and oncology
• Diagnostic imaging and radiology
• Surgical pathology and biopsy analysis

Background:

• Flat epithelial atypia (FEA) diagnosed on core needle biopsy has a variable malignant upgrade rate (0-30%).
• The optimal management strategy for FEA (excision vs. observation) remains debated.
• This study investigates the local upgrade rate and safety of radiological surveillance for pure FEA.

Purpose of the Study:

• To determine the local rate of malignant upgrade for pure flat epithelial atypia (FEA) diagnosed on breast core needle biopsy.
• To evaluate the safety and efficacy of radiological follow-up as a management option for pure FEA.

Main Methods:

• Retrospective review of a provincial pathology database (2006-2016) for patients with pure FEA on core needle biopsy.
• Exclusion of cases with concurrent in situ or invasive carcinoma.
• Analysis of patient demographics, lesion size, biopsy method, and final pathology; independent pathological review for confirmation.

Main Results:

• The local malignant upgrade rate for pure FEA was 12%.
• No significant correlation was found between upgrade risk and patient age, lesion size, biopsy method (including VAB), or imaging concordance.
• No malignant upgrades occurred in patients managed with radiological follow-up.

Conclusions:

• The local malignant upgrade rate aligns with published literature.
• Radiological follow-up is a safe alternative for pure FEA with concordant imaging, especially for small lesions.
• Vacuum-assisted biopsy may facilitate complete microcalcification removal in selected cases managed with surveillance.