University of Pittsburgh Medical Center, Pittsburgh, PA.
Am J Clin Pathol. 2019 Apr 2;151(5):511-515. doi: 10.1093/ajcp/aqy175.
We present a retrospective review of 111 breast core biopsy specimens with flat epithelial atypia (FEA) and corresponding excision to better understand rates of upgrade following this diagnosis.
In total, 252 breast core biopsy specimens were identified. Cases were excluded if biopsy slides or excision results were unavailable, for ipsilateral carcinoma or other findings warranting excision, or biopsy performed for indications other than mammographically detected calcifications. Coincident atypical lobular hyperplasia was not excluded. Diagnoses were confirmed by breast pathologists, and mammographic images were reviewed.
Ultimately, 111 biopsy specimens with FEA were included. In subsequent excisions, one (1%) of 111 showed invasive carcinoma, 20 (18%) atypical ductal hyperplasia, 20 (18%) lobular neoplasia, 31 (28%) FEA, and 39 (35%) no atypical findings.
FEA on core biopsy specimens is associated with a low rate of upgrade to invasive carcinoma. Close follow-up may be a reasonable alternative to excision for isolated FEA on core needle biopsy specimens.
我们回顾性分析了 111 例伴有平坦上皮不典型（FEA）的乳腺核心活检标本，并对相应的切除标本进行了研究，以更好地了解在诊断为 FEA 后升级为浸润性癌的比例。
共分析了 252 例乳腺核心活检标本。如果活检切片或切除结果不可用、同侧癌或其他需要切除的发现、或活检是为了检测乳腺 X 线摄影发现的钙化以外的其他指征，则排除这些病例。同时排除伴有不典型小叶增生的病例。由乳腺病理学家对诊断进行确认，并对乳腺 X 线摄影图像进行了回顾。
最终纳入了 111 例有 FEA 的活检标本。在后续的切除标本中，111 例中有 1 例（1%）为浸润性癌，20 例（18%）为非典型导管增生，20 例（18%）为小叶肿瘤，31 例（28%）为 FEA，39 例（35%）为无不典型发现。
在核心活检标本中，FEA 与浸润性癌升级的发生率较低相关。对于核心针活检标本中孤立性 FEA，密切随访可能是切除的合理替代方案。
