Erin Alencherry1, Rakhee Goel2, Sarah Gore2, Cheryl Thompson3, Christina Dubchuk2, Philip Bomeisl4, Hannah Gilmore5, Kathryn Dyhdalo6, Donna M Plecha7. 1. Mather Pavilion B402, 11100 Euclid Avenue, Cleveland, OH, 44106, United States of America. Electronic address: Erin.Alencherry@uhhospitals.org. 2. Mather Pavilion B402, 11100 Euclid Avenue, Cleveland, OH, 44106, United States of America. 3. 10900 Euclid Ave., Cleveland, OH, 44106, United States of America. Electronic address: clw8@case.edu. 4. 11100 Euclid Ave., Cleveland, OH, 44106, United States of America. Electronic address: Phillip.Bomeisl@uhhospitals.org. 5. 11100 Euclid Ave., Cleveland, OH, 44106, United States of America. Electronic address: Hannah.Gilmore@uhhospitals.org. 6. 9500 Euclid Avenue, Cleveland, OH, 44195, United States of America. 7. Mather Pavilion B402, 11100 Euclid Avenue, Cleveland, OH, 44106, United States of America. Electronic address: Donna.Plecha@uhhospitals.org.
Abstract
PURPOSE: This study aims to determine clinical, imaging, and intervention factors associated with the upgrade of flat epithelial atypia (FEA) diagnosed on vacuum-assisted biopsy (VAB) in order to formulate criteria for excision and better assist in management. METHODS: Between 2012 and 2015, 254 patients had a form of atypia diagnosed on ultrasound, MRI or stereotactic VAB and met eligibility for this study. Demographic, imaging, biopsy and pathology characteristics were analyzed for association with upgrade. We compared isolated FEA to all of the atypias grouped together. RESULTS: Of the 254 atypia lesions, 72 (28%) were isolated FEA, and the upgrade rate was 2.8% (2/72). Statistically significant factors present with upgrade of isolated FEA include personal history of breast cancer and cancer diagnosis on a concurrent separate core biopsy. Other factors associated with upgrade include first degree family history of breast cancer, segmental calcification distribution, extent of calcifications >2 cm, and <25% of calcifications removed on biopsy. CONCLUSION: In patients with biopsy results of isolated FEA, in the absence of personal or first degree family history of breast cancer, cancer on a concurrent biopsy, segmental calcification distribution, extent of calcifications >2 cm, and only 0-24% calcifications removed on biopsy, patients may be safely followed with imaging, avoiding unnecessary excision.
PURPOSE: This study aims to determine clinical, imaging, and intervention factors associated with the upgrade of flat epithelial atypia (FEA) diagnosed on vacuum-assisted biopsy (VAB) in order to formulate criteria for excision and better assist in management. METHODS: Between 2012 and 2015, 254 patients had a form of atypia diagnosed on ultrasound, MRI or stereotactic VAB and met eligibility for this study. Demographic, imaging, biopsy and pathology characteristics were analyzed for association with upgrade. We compared isolated FEA to all of the atypias grouped together. RESULTS: Of the 254 atypia lesions, 72 (28%) were isolated FEA, and the upgrade rate was 2.8% (2/72). Statistically significant factors present with upgrade of isolated FEA include personal history of breast cancer and cancer diagnosis on a concurrent separate core biopsy. Other factors associated with upgrade include first degree family history of breast cancer, segmental calcification distribution, extent of calcifications >2 cm, and <25% of calcifications removed on biopsy. CONCLUSION: In patients with biopsy results of isolated FEA, in the absence of personal or first degree family history of breast cancer, cancer on a concurrent biopsy, segmental calcification distribution, extent of calcifications >2 cm, and only 0-24% calcifications removed on biopsy, patients may be safely followed with imaging, avoiding unnecessary excision.