Department of Pathology, Carle Foundation Hospital, Urbana, IL 61801, USA.
Virchows Arch. 2012 Oct;461(4):419-23. doi: 10.1007/s00428-012-1312-1. Epub 2012 Sep 8.
Flat epithelial atypia (FEA) of the breast have a tendency to calcify and, as such, are becoming increasingly detected by mammography. There is no consensus yet on whether to excise these lesions or not after diagnosis on core needle biopsies (CNB). We reviewed 3,948 cases of breast CNB between June 2004 and June 2009 correlating histomorphologic, radiological, and clinical features. There were 3.7 % (145/3,948) pure FEA and 1.5 % (58/3,948) concomitant FEA and atypical ductal hyperplasia (ADH). In the pure FEA population, 46.2 % (67/145) had microcalcifications on mammography with 65.5 % (95/145) of patients undergoing subsequent excisional biopsies with the following findings: benign 20 % (19/95), ADH 37.9 % (36/95), ductal carcinoma in situ (DCIS) 1.1 % (1/95), and DCIS and invasive ductal carcinoma (IDC) 2.1 % (2/95). In the concomitant FEA and ADH group, 86.2 % (50/58) patients had microcalcifications on radiograph with 74.1 % (43/58) of patients undergoing subsequent excisions with: benign 23.3 % (10/43), DCIS 9.3 % (4/43), DCIS and IDC 4.7 % (2/43), DCIS + lobular carcinoma in situ + invasive lobular carcinoma 2.3 % (1/43), and tubular carcinoma 2.3 % (1/43). The incidence of carcinoma in the FEA + ADH group is 18.6 % (8/43) and 3.2 % (3/95) for the pure FEA group. This difference is statistically significant (p = 0.0016). The relative risk of carcinoma in the ADH + FEA group versus the pure FEA group is 6.4773, with 95 % CI of 1.8432 and 22.76 24. Five-year mean follow-up in the unexcised pure FEA did not show any malignancies. These findings suggest that pure FEA has a very low association with carcinoma, and these patients may benefit from close clinical and mammographic follow-up while the combined pure FEA and ADH cases may be re-excised.
乳腺的扁平上皮不典型（FEA）有钙化的倾向，因此，越来越多地通过乳房 X 线照相术检测到。对于在核心针活检（CNB）后是否切除这些病变，目前尚无共识。我们回顾了 2004 年 6 月至 2009 年 6 月期间的 3948 例乳腺 CNB 病例，相关的组织形态学、放射学和临床特征。纯 FEA 占 3.7%（145/3948），同时伴有 FEA 和非典型导管增生（ADH）占 1.5%（58/3948）。在纯 FEA 人群中，46.2%（67/145）在乳房 X 线照相术上有微钙化，65.5%（95/145）的患者接受了随后的切除活检，以下是活检结果：良性 20%（19/95）、ADH 37.9%（36/95）、导管原位癌（DCIS）1.1%（1/95）和 DCIS 伴浸润性导管癌（IDC）2.1%（2/95）。在同时伴有 FEA 和 ADH 的人群中，86.2%（50/58）的患者在 X 线照相上有微钙化，74.1%（43/58）的患者接受了随后的切除活检，结果为：良性 23.3%（10/43）、DCIS 9.3%（4/43）、DCIS 伴 IDC 4.7%（2/43）、DCIS+小叶原位癌+浸润性小叶癌 2.3%（1/43）和管状癌 2.3%（1/43）。FEA+ADH 组的癌发生率为 18.6%（8/43），纯 FEA 组为 3.2%（3/95）。这一差异具有统计学意义（p=0.0016）。ADH+FEA 组与纯 FEA 组相比，癌的相对风险为 6.4773，95%置信区间为 1.8432 和 22.76 24。未经切除的纯 FEA 的 5 年平均随访未显示任何恶性肿瘤。这些发现表明，纯 FEA 与癌的相关性非常低，这些患者可能受益于密切的临床和乳房 X 线照相随访，而同时伴有纯 FEA 和 ADH 的病例可能需要再次切除。
