Gordon Paula B, Branch Emma
BC Women's Hospital and Health Care Centre, Sadie Diamond Breast Program, Vancouver, BC, Canada.
BC Women's Health Research Institute, Vancouver, BC, Canada.
J Breast Imaging. 2020 Aug 10;2(4):336-342. doi: 10.1093/jbi/wbaa037.
Whether the optimal management of pure flat epithelial atypia (FEA) found on core needle biopsy (CNB) specimens is surgical excision or imaging follow-up remains controversial. This study aimed to determine the upgrade rate to ductal carcinoma in situ (DCIS), invasive carcinoma or a high-risk lesion (atypical ductal hyperplasia, atypical lobular hyperplasia, or lobular carcinoma in situ), and it explored the relationship between a family history of breast cancer and the risk of upgrade.
Cases with pure FEA found on stereotactic CNB of microcalcifications between March 2011 to December 2017 were followed by excisional biopsy or periodic imaging. The proportion of cases upgraded to a high-risk lesion and the odds of upgrade as related to a family history of breast cancer were determined with 95% confidence intervals (CIs).
We identified 622 cases of pure FEA; 101 (16.2%) underwent surgical excision and 269 (43.2%) had imaging follow-up of ≥ 24 months. There were no upgrades to DCIS or invasive cancer in any of these 370 individuals (0%), and 4.6% (17/370; 95% CI: 2.9%-7.2%) were upgraded to a high-risk lesion. There was a nonstatistically significant trend between family history and upgrade to high-risk lesion (odds ratio 1.72 [95% CI: 0.65%-4.57%]).
In our study, the upgrade rate of pure FEA to malignancy was 0%. We suggest that regular imaging follow-up is an appropriate alternative to surgery. Because of potential differences in biopsy techniques and pathologist interpretation of the primary biopsy, individual institutions should audit their own results prior to altering their management of FEA.
对于在粗针活检（CNB）标本中发现的单纯扁平上皮异型增生（FEA），最佳处理方式是手术切除还是影像随访仍存在争议。本研究旨在确定其升级为导管原位癌（DCIS）、浸润性癌或高危病变（非典型导管增生、非典型小叶增生或小叶原位癌）的比例，并探讨乳腺癌家族史与升级风险之间的关系。
对2011年3月至2017年12月间在立体定向CNB检查微钙化时发现单纯FEA的病例进行切除活检或定期影像随访。确定升级为高危病变的病例比例以及与乳腺癌家族史相关的升级几率，并给出95%置信区间（CI）。
我们共识别出622例单纯FEA病例；101例（16.2%）接受了手术切除，269例（43.2%）接受了≥24个月的影像随访。这370例患者中均无升级为DCIS或浸润性癌的情况（0%），4.6%（17/370；95%CI：2.9%-7.2%）升级为高危病变。家族史与升级为高危病变之间存在无统计学意义的趋势（优势比1.72[95%CI：0.65%-4.57%]）。
在我们的研究中，单纯FEA升级为恶性肿瘤的比例为0%。我们建议定期影像随访是手术的合适替代方案。由于活检技术和病理学家对初次活检的解读可能存在差异，各机构在改变其对FEA的处理方式之前应审核自身结果。
