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Is Excisional Biopsy Needed for Pure FEA Diagnosed on a Core Biopsy?

Publication ,  Journal Article
Miller-Ocuin, JL; Fowler, BB; Coldren, DL; Chiba, A; Levine, EA; Howard-McNatt, M
Published in: Am Surg
September 2020

BACKGROUND: The management of flat epithelial atypia (FEA) on core needle biopsy remains controversial. The upstaging rates after surgical excision are variable. In this study, we seek to determine the upstaging rate of FEA at our institution. METHODS: Patients with a diagnosis of FEA were identified from the institution's pathology database from 2009 to 2018. Patients were included in the study if FEA alone, without atypia or cancer, was identified on core needle biopsy. Patient demographics, imaging, management, and pathology characteristics were obtained. Statistical analysis performed using IBM SPSS 26.0 (Armonk, NY, USA). RESULTS: FEA was diagnosed on core needle biopsy in 235 patients from 2009 to December 2018. Forty-eight patients met the inclusion criteria. The majority of patients presented with calcifications on mammogram (n = 21, 64%) with the remainder as masses (n = 6, 18%) or architectural distortion (n = 6, 18%). Of those, 15 (31%) patients declined surgical excision, of which none developed cancer over a mean follow-up of 4.4 years. Of the 33 (69%) patients undergoing excisional biopsy, 17 (52%) confirmed FEA, 11 (33%) had benign findings, and 3 (9%) demonstrated atypical ductal hyperplasia on final pathology. One (3%) case revealed ductal carcinoma in situ (DCIS) and 1 (3%) was upgraded to invasive cancer for an overall upstaging rate of 4% (2/48). After a mean follow-up of 3.4 years, none of the excisional biopsy patients developed invasive breast cancer. Adjuvant therapy was used in the cases of DCIS and invasive cancer; however, chemoprevention with raloxifene or tamoxifen was not chosen by any of the remaining patients. CONCLUSION: In our cohort, expectant management of FEA alone appears to be a safe option as our upstaging rate to DCIS or invasive cancer for FEA diagnosed on core biopsy was only 4%. Our study suggests that close follow-up is a safe and feasible option for pure FEA without a radiographic discordance found on core biopsy.

Duke Scholars

Published In

Am Surg

DOI

EISSN

1555-9823

Publication Date

September 2020

Volume

86

Issue

9

Start / End Page

1088 / 1090

Location

United States

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Reproducibility of Results
  • Precancerous Conditions
  • Neoplasm Staging
  • Middle Aged
  • Humans
  • Female
  • Diagnosis, Differential
  • Breast Neoplasms
 

Citation

APA
Chicago
ICMJE
MLA
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Miller-Ocuin, J. L., Fowler, B. B., Coldren, D. L., Chiba, A., Levine, E. A., & Howard-McNatt, M. (2020). Is Excisional Biopsy Needed for Pure FEA Diagnosed on a Core Biopsy? Am Surg, 86(9), 1088–1090. https://doi.org/10.1177/0003134820943546
Miller-Ocuin, Jennifer L., Brett B. Fowler, Daniel L. Coldren, Akiko Chiba, Edward A. Levine, and Marissa Howard-McNatt. “Is Excisional Biopsy Needed for Pure FEA Diagnosed on a Core Biopsy?Am Surg 86, no. 9 (September 2020): 1088–90. https://doi.org/10.1177/0003134820943546.
Miller-Ocuin JL, Fowler BB, Coldren DL, Chiba A, Levine EA, Howard-McNatt M. Is Excisional Biopsy Needed for Pure FEA Diagnosed on a Core Biopsy? Am Surg. 2020 Sep;86(9):1088–90.
Miller-Ocuin, Jennifer L., et al. “Is Excisional Biopsy Needed for Pure FEA Diagnosed on a Core Biopsy?Am Surg, vol. 86, no. 9, Sept. 2020, pp. 1088–90. Pubmed, doi:10.1177/0003134820943546.
Miller-Ocuin JL, Fowler BB, Coldren DL, Chiba A, Levine EA, Howard-McNatt M. Is Excisional Biopsy Needed for Pure FEA Diagnosed on a Core Biopsy? Am Surg. 2020 Sep;86(9):1088–1090.

Published In

Am Surg

DOI

EISSN

1555-9823

Publication Date

September 2020

Volume

86

Issue

9

Start / End Page

1088 / 1090

Location

United States

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Reproducibility of Results
  • Precancerous Conditions
  • Neoplasm Staging
  • Middle Aged
  • Humans
  • Female
  • Diagnosis, Differential
  • Breast Neoplasms