El Khoury Mona, Sanchez Lilia Maria, Lalonde Lucie, Trop Isabelle, David Julie, Mesurolle Benoît
1 Department of Radiology, Breast Centre, Centre Hospitalier Universitaire de Montréal, Montreal, QC, Canada.
2 Department of Pathology, Centre Hospitalier Universitaire de Montréal, Montreal, QC, Canada.
Br J Radiol. 2017 Apr;90(1072):20160750. doi: 10.1259/bjr.20160750. Epub 2017 Mar 3.
To assess the impact on the final outcome at surgery of flat epithelial atypia (FEA) when found concomitantly with lobular neoplasia (LN) in biopsy specimens compared with pure biopsy-proven FEA.
The approval from the institutional review board of the CHUM (Centre Hospitalier Universitaire de Montréal) was obtained. A retrospective review of our database between 2009 and 2013 identified 81 females (mean age 54 years, range 38-90 years) with 81 FEA biopsy-proven lesions. These were pure or associated with LN only in 59/81 (73%) and 22/81 (27%) cases, respectively. Overall, 57/81 (70%) patients underwent surgery and 24/81 (30%) patients underwent mammographic surveillance with a mean follow-up of 36 months.
FEA presented more often as microcalcifications in 68/81 (84%) patients and were mostly amorphous in 49/68 (72%). After excluding radio pathologically discordant cases, pure FEA proved to be malignant at surgery in 1/41 (2%; 95% confidence interval 0.06-12.9). There was no statistically significant difference in the upgrade to malignancy whether FEA lesions were pure or associated to LN at biopsy (p = 0.4245); however, when paired in biopsy specimens, these lesions were more frequently associated with atypical ductal hyperplasia (ADH) at surgery than with pure FEA (p = 0.012).
Our results show a 2% upgrade rate to malignancy of pure FEA lesions. When FEA is found in association with LN at biopsy, surgical excision yields more frequently ADH than pure FEA thus warranting close surveillance or even surgical excision. Advances in knowledge: The association of LN with FEA at biopsy was more frequently associated with ADH at surgery than with pure FEA. If a biopsy-proven FEA lesion is deemed concordant with the imaging finding, when paired with LN at biopsy, careful surveillance or even surgical excision is suggested.
评估活检标本中扁平上皮异型增生（FEA）与小叶瘤变（LN）同时存在时对手术最终结果的影响，并与单纯经活检证实的FEA进行比较。
获得了蒙特利尔大学中心医院（CHUM）机构审查委员会的批准。对2009年至2013年期间我们数据库的回顾性研究确定了81名女性（平均年龄54岁，范围38 - 90岁），她们有81个经活检证实的FEA病变。这些病变分别在59/81（73%）和22/81（27%）的病例中为单纯性或仅与LN相关。总体而言，57/81（70%）的患者接受了手术，24/81（30%）的患者接受了乳房X线监测，平均随访36个月。
68/81（84%）的患者中FEA更多表现为微钙化，其中49/68（72%）主要为无定形。排除放射病理学不一致的病例后，单纯FEA在手术中被证实为恶性的比例为1/41（2%；95%置信区间0.06 - 12.9）。活检时FEA病变是单纯性还是与LN相关，其恶性升级情况无统计学显著差异（p = 0.4245）；然而，在活检标本中配对时，这些病变在手术中与非典型导管增生（ADH）的关联比与单纯FEA更频繁（p = 0.012）。
我们的结果显示单纯FEA病变的恶性升级率为2%。当活检时发现FEA与LN相关时，手术切除产生ADH的频率比单纯FEA更高，因此需要密切监测甚至手术切除。知识进展：活检时LN与FEA的关联在手术中与ADH的关联比与单纯FEA更频繁。如果经活检证实的FEA病变被认为与影像学发现一致，当活检时与LN配对时，建议进行仔细监测甚至手术切除。
