Nakhlis Faina, Baker Gabrielle M, Li Tianyu, McAuliffe Priscilla F, Plitas George, Ludwig Kandice K, Boisvert Marc, Rosenberger Laura H, Gallagher Kristalyn K, Jacobs Lisa, Nimbkar Suniti N, Feldman Sheldon, Lange Paulina, Attaya Victoria, DeMeo Michelle, Fraettarelli Ashton, Schnitt Stuart J, King Tari A
Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
Ann Surg Oncol. 2025 Apr;32(4):2578-2584. doi: 10.1245/s10434-024-16762-z. Epub 2025 Jan 3.
Flat epithelial atypia (FEA), a rare breast proliferative lesion, is often diagnosed following core biopsy (CB) of mammographic microcalcifications. In the prospective multi-institution TBCRC 034 trial, we investigate the upgrade rate to ductal carcinoma in situ (DCIS) or invasive cancer following excision for patients diagnosed with FEA on CB.
Patients with a breast imaging reporting and data system (BI-RADS) ≤ 4 imaging abnormality and a concordant CB diagnosis of FEA were identified for excision. Upgrade rates were determined on the basis of local and central pathology review. The prespecified threshold to omit excision of FEA on CB was an upgrade rate of ≤ 3%. Sample size and confidence intervals were based on exact binomial calculation.
Overall, 129 patients underwent excision (median age 50 years, range 30-84 years). After local pathology review, 6/129 patients (4.7%; 95% CI 1.7-9.8%) were upgraded to invasive carcinoma (n = 3) or DCIS (n = 3) at excision. Among 116 patients with CB available for central pathology review, FEA was confirmed in 78 (67.2%, 95% CI 57.9-75.7%). Of these, only one patient was upgraded to DCIS (1.3%; 95% CI 0.03-6.9%), which was also one of the locally upgraded cases. Among the other five local upgrades, two did not have CB available for central review, two CB had ADH, and one CB had normal tissue on central review.
Among patients with FEA on CB, the upgrade rate was 4.7% based on local pathology review and 1.3% based on central pathology review. These findings highlight the importance of shared decision-making in the management of FEA.
扁平上皮异型增生（FEA）是一种罕见的乳腺增殖性病变，常在乳腺钼靶微钙化灶的粗针活检（CB）后被诊断出来。在多机构前瞻性TBCRC 034试验中，我们调查了CB诊断为FEA的患者切除术后原位导管癌（DCIS）或浸润性癌的升级率。
确定乳腺影像报告和数据系统（BI-RADS）≤4级影像异常且CB诊断为FEA一致的患者进行切除。升级率根据局部和中心病理检查确定。CB时省略FEA切除的预定阈值是升级率≤3%。样本量和置信区间基于精确二项式计算。
总体而言，129例患者接受了切除（中位年龄50岁，范围30 - 84岁）。经局部病理检查后，129例患者中有6例（4.7%；95%CI 1.7 - 9.8%）在切除时升级为浸润性癌（n = 3）或DCIS（n = 3）。在116例可进行中心病理检查的CB患者中，78例（67.2%，95%CI 57.9 - 75.7%）确诊为FEA。其中，只有1例患者升级为DCIS（1.3%；95%CI 0.03 - 6.9%），这也是局部升级的病例之一。在其他5例局部升级病例中，2例没有可用于中心检查的CB，2例CB经中心检查有非典型导管增生（ADH），1例CB经中心检查为正常组织。
CB诊断为FEA的患者中，基于局部病理检查的升级率为4.7%，基于中心病理检查的升级率为1.3%。这些发现凸显了FEA管理中共同决策的重要性。
