Flat epithelial atypia and the risk of sampling error: Determining the value of excision after image-guided core-needle biopsy

Leah K Winer; Benjamin H Hinrichs; Sisi Lu; Dennis Hanseman; Yuan Huang; Chantal Reyna; Jaime Lewis; Elizabeth A Shaughnessy

doi:10.1016/j.amjsurg.2019.07.020

Flat epithelial atypia and the risk of sampling error: Determining the value of excision after image-guided core-needle biopsy

Am J Surg. 2019 Oct;218(4):730-736. doi: 10.1016/j.amjsurg.2019.07.020. Epub 2019 Jul 18.

Authors

Leah K Winer¹, Benjamin H Hinrichs², Sisi Lu¹, Dennis Hanseman¹, Yuan Huang², Chantal Reyna¹, Jaime Lewis¹, Elizabeth A Shaughnessy³

Affiliations

¹ Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way (ML 0558), Cincinnati, OH, 45267, USA.
² Department of Pathology, University of Cincinnati College of Medicine, 234 Goodman Street, Suite 110, Cincinnati, OH, 45219, USA.
³ Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way (ML 0558), Cincinnati, OH, 45267, USA. Electronic address: shaughea@ucmail.uc.edu.

PMID: 31399195
DOI: 10.1016/j.amjsurg.2019.07.020

Abstract

Background: We determined the sampling error rate of flat epithelial atypia (FEA) and evaluated current guidelines recommending excisional biopsy.

Methods: A retrospective review of consecutive excisional biopsies after image-guided core-needle biopsy identified patients with isolated FEA diagnosed between 2014 and 2018. Clinical and pathologic parameters were evaluated.

Results: Twenty-five women with 27 biopsies were included. Based on pathologic review of original core specimens, 44.4% (N = 12) were accurately diagnosed as FEA. Upon excision, lesions were upgraded to ductal carcinoma in situ (N = 2) or invasive ductal carcinoma (N = 1) in 11.1% of cases. Older age, black race, hormone replacement, and calcifications in the image-guided biopsy specimen were associated with the presence of high-risk or malignant lesions in the excisional biopsy (all p ≤ 0.05).

Conclusions: In this study, FEA was frequently overcalled. However, lesions suspicious for FEA warrant excision due to their association with malignancy or high-risk lesions, which may necessitate further surgical management and/or risk-reducing strategies.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biopsy, Large-Core Needle*
Breast Neoplasms / pathology*
Breast Neoplasms / surgery
Carcinoma / pathology*
Carcinoma / surgery
Epithelial Cells / pathology*
Female
Humans
Hyperplasia
Image-Guided Biopsy*
Middle Aged
Predictive Value of Tests
Retrospective Studies
Selection Bias