Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way (ML 0558), Cincinnati, OH, 45267, USA.
Department of Pathology, University of Cincinnati College of Medicine, 234 Goodman Street, Suite 110, Cincinnati, OH, 45219, USA.
Am J Surg. 2019 Oct;218(4):730-736. doi: 10.1016/j.amjsurg.2019.07.020. Epub 2019 Jul 18.
We determined the sampling error rate of flat epithelial atypia (FEA) and evaluated current guidelines recommending excisional biopsy.
A retrospective review of consecutive excisional biopsies after image-guided core-needle biopsy identified patients with isolated FEA diagnosed between 2014 and 2018. Clinical and pathologic parameters were evaluated.
Twenty-five women with 27 biopsies were included. Based on pathologic review of original core specimens, 44.4% (N = 12) were accurately diagnosed as FEA. Upon excision, lesions were upgraded to ductal carcinoma in situ (N = 2) or invasive ductal carcinoma (N = 1) in 11.1% of cases. Older age, black race, hormone replacement, and calcifications in the image-guided biopsy specimen were associated with the presence of high-risk or malignant lesions in the excisional biopsy (all p ≤ 0.05).
In this study, FEA was frequently overcalled. However, lesions suspicious for FEA warrant excision due to their association with malignancy or high-risk lesions, which may necessitate further surgical management and/or risk-reducing strategies.
我们确定了扁平上皮不典型（FEA）的抽样误差率，并评估了目前推荐进行切除术活检的指南。
对 2014 年至 2018 年间经影像引导下空心针活检诊断为孤立性 FEA 的连续切除术活检患者进行回顾性研究。评估了临床和病理参数。
纳入了 25 名女性的 27 次活检。根据对原始空心针活检标本的病理复查，44.4%（N=12）准确诊断为 FEA。在切除后，11.1%的病例中病变升级为导管原位癌（N=2）或浸润性导管癌（N=1）。在切除活检中，年龄较大、黑种人、激素替代治疗和影像引导活检标本中的钙化与高危或恶性病变的存在相关（均 p≤0.05）。
在这项研究中，FEA 经常被过度诊断。然而，可疑 FEA 的病变需要切除，因为它们与恶性或高危病变相关，这可能需要进一步的手术管理和/或降低风险的策略。
