Clinical, imaging, and intervention factors associated with the upgrade of isolated flat epithelial atypia

Publication date: Available online 20 November 2018

Source: Clinical Imaging

Author(s): Erin Alencherry, Rakhee Goel, Sarah Gore, Cheryl Thompson, Christina Dubchuk, Philip Bomeisl, Hannah Gilmore, Kathryn Dyhdalo, Donna M. Plecha

Abstract

Purpose

This study aims to determine clinical, imaging, and intervention factors associated with the upgrade of flat epithelial atypia (FEA) diagnosed on vacuum-assisted biopsy (VAB) in order to formulate criteria for excision and better assist in management.

Methods

Between 2012 and 2015, 254 patients had a form of atypia diagnosed on ultrasound, MRI or stereotactic VAB and met eligibility for this study. Demographic, imaging, biopsy and pathology characteristics were analyzed for association with upgrade. We compared isolated FEA to all of the atypias grouped together.

Results

Of the 254 atypia lesions, 72 (28%) were isolated FEA, and the upgrade rate was 2.8% (2/72). Statistically significant factors present with upgrade of isolated FEA include personal history of breast cancer and cancer diagnosis on a concurrent separate core biopsy. Other factors associated with upgrade include first degree family history of breast cancer, segmental calcification distribution, extent of calcifications >2 cm, and <25% of calcifications removed on biopsy.

Conclusion

In patients with biopsy results of isolated FEA, in the absence of personal or first degree family history of breast cancer, cancer on a concurrent biopsy, segmental calcification distribution, extent of calcifications >2 cm, and only 0–24% calcifications removed on biopsy, patients may be safely followed with imaging, avoiding unnecessary excision.

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