Pure Flat Epithelial Atypia (FEA) on Sterotactic Biopsies Performed In Clinica Alemana de Santiago

Abstract

FOREWORD: Flat Epithelial Atypia (FEA) is one of the high-risk breast lesions (HRL), with low degree cytological atypia. Its management (surgery v/s intensive follow-up) after percutaneous procedures diagnosis is still controversial. OBJECTIVES: The goal of the study was to determine the frequency of pure FEA on stereotactic biopsies (SB) and the histological underestimation (HU) after it s surgical excision. MATERIALS AND METHODS: Retrospective review of 537 SB performed in 485 women (30-72 yr), old (mean 49.9 yr. ) in Clinica Alemana de Santiago between June 2009 and April 2012. To assess HU, were excluded cases with other high-risk lesions (atypical ductal hyperplasia, lobular neoplasia, radial scar, mucocelelike lesions, papillary lesions) and ductal carcinoma in situ (DCIS) or invasive cancer in the SB histology. Also excluded pure FEA cases that didn t undergo surgical excision. RESULTS: Of all biopsied focuses, 217 (40.4%) were high risk lesions, and FEA was found on 175 of them (80.6%). Pure FEA was diagnosed in 38 cases (7% total; 17.5% HRL); of such 20 (52.6%) underwent surgical excision. (i) No cases with DCIS or invasive cancer (UH 0%) was found in the definitive histology.(ii) 40 % of FEA cases were associated to atypical ductal hyperplasia and 20% to lobular neoplasia. From the 18 patients did not undergo surgery, 10 (55.5%) continued to be monitored, with a mean follow-up of 14 month. Only one case showed progression of residual micro-calcifications, and was suggested to biopsy again. CONCLUSION: FEA is a diagnosis to by familiar with, especially because of lack of enough scientific evidence that allows to create handling patterns after is diagnosed by percutaneal procedures. Our results suggest that surgery may not be needed in all cases, especially when FEA appears as a collateral finding, or unique focus, microfocus or when a full extraction of micro-calcifications during biopsy is achieved.