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Flat ductal epithelial atypia

MedGen UID:
232508
•Concept ID:
C1333620
•
Neoplastic Process
Synonyms: Breast Flat Ductal Epithelial Atypia; Clinging Carcinoma; clinging carcinoma; DIN 1A; Ductal Intraepithelial Neoplasia, Grade 1A; ductal intraepithelial neoplasia, grade 1A; FEA; Flat Ductal Epithelial Atypia; flat ductal epithelial atypia; Flat Ductal Epithelial Atypia of the Breast; flat ductal epithelial atypia of the breast; Flat Epithelial Atypia; flat epithelial atypia; Flat epithelial atypia of breast; Flat Epithelial Atypia of the Breast; flat epithelial atypia of the breast
SNOMED CT: Flat epithelial atypia of breast (860895001)
 
Monarch Initiative: MONDO:0004008

Definition

A breast lesion characterized by the presence of dilated terminal ductal lobular units in which the epithelial lining has been replaced by a single layer of mildly atypical cells, or there is atypical, monotonous epithelial hyperplasia of three to five layers. This lesion relates to columnar cell change with atypia and columnar cell hyperplasia with atypia. [from NCI]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVFlat ductal epithelial atypia

Recent clinical studies

Etiology

European guidelines for the diagnosis, treatment and follow-up of breast lesions with uncertain malignant potential (B3 lesions) developed jointly by EUSOMA, EUSOBI, ESP (BWG) and ESSO.
Rubio IT, Wyld L, Marotti L, Athanasiou A, Regitnig P, Catanuto G, Schoones JW, Zambon M, Camps J, Santini D, Dietz J, Sardanelli F, Varga Z, Smidt M, Sharma N, Shaaban AM, Gilbert F
Eur J Surg Oncol 2024 Jan;50(1):107292. Epub 2023 Nov 27 doi: 10.1016/j.ejso.2023.107292. PMID: 38061151
Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions).
Elfgen C, Leo C, Kubik-Huch RA, Muenst S, Schmidt N, Quinn C, McNally S, van Diest PJ, Mann RM, Bago-Horvath Z, Bernathova M, Regitnig P, Fuchsjäger M, Schwegler-Guggemos D, Maranta M, Zehbe S, Tausch C, Güth U, Fallenberg EM, Schrading S, Kothari A, Sonnenschein M, Kampmann G, Kulka J, Tille JC, Körner M, Decker T, Lax SF, Daniaux M, Bjelic-Radisic V, Kacerovsky-Strobl S, Condorelli R, Gnant M, Varga Z
Virchows Arch 2023 Jul;483(1):5-20. Epub 2023 Jun 17 doi: 10.1007/s00428-023-03566-x. PMID: 37330436Free PMC Article
Management of High-Risk Breast Lesions.
Bahl M
Radiol Clin North Am 2021 Jan;59(1):29-40. doi: 10.1016/j.rcl.2020.08.005. PMID: 33222998
How Do We Approach Benign Proliferative Lesions?
Nakhlis F
Curr Oncol Rep 2018 Mar 23;20(4):34. doi: 10.1007/s11912-018-0682-1. PMID: 29572753
Core Needle Biopsy of the Breast: An Evaluation of Contemporary Data.
Calhoun BC
Surg Pathol Clin 2018 Mar;11(1):1-16. Epub 2017 Dec 6 doi: 10.1016/j.path.2017.09.001. PMID: 29413652

Diagnosis

European guidelines for the diagnosis, treatment and follow-up of breast lesions with uncertain malignant potential (B3 lesions) developed jointly by EUSOMA, EUSOBI, ESP (BWG) and ESSO.
Rubio IT, Wyld L, Marotti L, Athanasiou A, Regitnig P, Catanuto G, Schoones JW, Zambon M, Camps J, Santini D, Dietz J, Sardanelli F, Varga Z, Smidt M, Sharma N, Shaaban AM, Gilbert F
Eur J Surg Oncol 2024 Jan;50(1):107292. Epub 2023 Nov 27 doi: 10.1016/j.ejso.2023.107292. PMID: 38061151
Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions).
Elfgen C, Leo C, Kubik-Huch RA, Muenst S, Schmidt N, Quinn C, McNally S, van Diest PJ, Mann RM, Bago-Horvath Z, Bernathova M, Regitnig P, Fuchsjäger M, Schwegler-Guggemos D, Maranta M, Zehbe S, Tausch C, Güth U, Fallenberg EM, Schrading S, Kothari A, Sonnenschein M, Kampmann G, Kulka J, Tille JC, Körner M, Decker T, Lax SF, Daniaux M, Bjelic-Radisic V, Kacerovsky-Strobl S, Condorelli R, Gnant M, Varga Z
Virchows Arch 2023 Jul;483(1):5-20. Epub 2023 Jun 17 doi: 10.1007/s00428-023-03566-x. PMID: 37330436Free PMC Article
Flat epithelial atypia: are we being too aggressive?
DiPasquale A, Silverman S, Farag E, Peiris L
Breast Cancer Res Treat 2020 Jan;179(2):511-517. Epub 2019 Nov 7 doi: 10.1007/s10549-019-05481-9. PMID: 31701300
How Do We Approach Benign Proliferative Lesions?
Nakhlis F
Curr Oncol Rep 2018 Mar 23;20(4):34. doi: 10.1007/s11912-018-0682-1. PMID: 29572753
Core Needle Biopsy of the Breast: An Evaluation of Contemporary Data.
Calhoun BC
Surg Pathol Clin 2018 Mar;11(1):1-16. Epub 2017 Dec 6 doi: 10.1016/j.path.2017.09.001. PMID: 29413652

Therapy

Upgrade Rate of Pure Flat Epithelial Atypia Diagnosed at Core Needle Biopsy: A Systematic Review and Meta-Analysis.
Wahab RA, Lee SJ, Mulligan ME, Zhang B, Mahoney MC
Radiol Imaging Cancer 2021 Jan;3(1):e200116. Epub 2021 Jan 22 doi: 10.1148/rycan.2021200116. PMID: 33778758Free PMC Article
B3 lesion upgrade rates in a tertiary Australian breast centre: a 8-year experience (2012-2019).
Huang YY, Park H, McLaren S, Thirunavukkarasu P, Lin JTW, Rajakaruna R, Dhillon R, Ponniah AK
ANZ J Surg 2020 Dec;90(12):2521-2526. Epub 2020 Sep 23 doi: 10.1111/ans.16315. PMID: 32969161
Risk of malignancy in papillary neoplasms of the breast.
Liu C, Sidhu R, Ostry A, Warburton R, Pao JS, Dingee C, Kuusk U, McKevitt E
Breast Cancer Res Treat 2019 Nov;178(1):87-94. Epub 2019 Jul 22 doi: 10.1007/s10549-019-05367-w. PMID: 31332665
Flat Epithelial Atypia on Core Biopsy and Upgrade to Cancer: a Systematic Review and Meta-Analysis.
Rudin AV, Hoskin TL, Fahy A, Farrell AM, Nassar A, Ghosh K, Degnim AC
Ann Surg Oncol 2017 Nov;24(12):3549-3558. Epub 2017 Aug 22 doi: 10.1245/s10434-017-6059-0. PMID: 28831724
All atypia diagnosed at stereotactic vacuum-assisted breast biopsy do not need surgical excision.
de Mascarel I, Brouste V, Asad-Syed M, Hurtevent G, Macgrogan G
Mod Pathol 2011 Sep;24(9):1198-206. Epub 2011 May 20 doi: 10.1038/modpathol.2011.73. PMID: 21602816

Prognosis

European guidelines for the diagnosis, treatment and follow-up of breast lesions with uncertain malignant potential (B3 lesions) developed jointly by EUSOMA, EUSOBI, ESP (BWG) and ESSO.
Rubio IT, Wyld L, Marotti L, Athanasiou A, Regitnig P, Catanuto G, Schoones JW, Zambon M, Camps J, Santini D, Dietz J, Sardanelli F, Varga Z, Smidt M, Sharma N, Shaaban AM, Gilbert F
Eur J Surg Oncol 2024 Jan;50(1):107292. Epub 2023 Nov 27 doi: 10.1016/j.ejso.2023.107292. PMID: 38061151
Flat epithelial atypia: are we being too aggressive?
DiPasquale A, Silverman S, Farag E, Peiris L
Breast Cancer Res Treat 2020 Jan;179(2):511-517. Epub 2019 Nov 7 doi: 10.1007/s10549-019-05481-9. PMID: 31701300
Flat epithelial atypia on core needle biopsy does not always mandate excisional biopsy.
Srour MK, Donovan C, Chung A, Harit A, Dadmanesh F, Giuliano AE, Amersi F
Breast J 2020 Apr;26(4):679-684. Epub 2019 Sep 28 doi: 10.1111/tbj.13507. PMID: 31562689
Flat Epithelial Atypia on Core Biopsy and Upgrade to Cancer: a Systematic Review and Meta-Analysis.
Rudin AV, Hoskin TL, Fahy A, Farrell AM, Nassar A, Ghosh K, Degnim AC
Ann Surg Oncol 2017 Nov;24(12):3549-3558. Epub 2017 Aug 22 doi: 10.1245/s10434-017-6059-0. PMID: 28831724
Positive predictive value for malignancy of pure flat epithelial atypia diagnosis by percutaneous needle biopsy of the breast: management of FEA in ultrasonography.
Maeda I, Kanemaki Y, Tozaki M, Koizumi H, Oana Y, Okanami Y, Tsuchiya K, Shimo A, Kojima Y, Hayami R, Nishikawa T, Kawamoto H, Yabuki Y, Tsugawa K, Takagi M
Breast Cancer 2015 Nov;22(6):634-40. Epub 2014 Apr 24 doi: 10.1007/s12282-014-0530-6. PMID: 24760612

Clinical prediction guides

Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions).
Elfgen C, Leo C, Kubik-Huch RA, Muenst S, Schmidt N, Quinn C, McNally S, van Diest PJ, Mann RM, Bago-Horvath Z, Bernathova M, Regitnig P, Fuchsjäger M, Schwegler-Guggemos D, Maranta M, Zehbe S, Tausch C, Güth U, Fallenberg EM, Schrading S, Kothari A, Sonnenschein M, Kampmann G, Kulka J, Tille JC, Körner M, Decker T, Lax SF, Daniaux M, Bjelic-Radisic V, Kacerovsky-Strobl S, Condorelli R, Gnant M, Varga Z
Virchows Arch 2023 Jul;483(1):5-20. Epub 2023 Jun 17 doi: 10.1007/s00428-023-03566-x. PMID: 37330436Free PMC Article
Flat epithelial atypia: are we being too aggressive?
DiPasquale A, Silverman S, Farag E, Peiris L
Breast Cancer Res Treat 2020 Jan;179(2):511-517. Epub 2019 Nov 7 doi: 10.1007/s10549-019-05481-9. PMID: 31701300
Flat epithelial atypia on core needle biopsy does not always mandate excisional biopsy.
Srour MK, Donovan C, Chung A, Harit A, Dadmanesh F, Giuliano AE, Amersi F
Breast J 2020 Apr;26(4):679-684. Epub 2019 Sep 28 doi: 10.1111/tbj.13507. PMID: 31562689
Flat Epithelial Atypia on Core Biopsy and Upgrade to Cancer: a Systematic Review and Meta-Analysis.
Rudin AV, Hoskin TL, Fahy A, Farrell AM, Nassar A, Ghosh K, Degnim AC
Ann Surg Oncol 2017 Nov;24(12):3549-3558. Epub 2017 Aug 22 doi: 10.1245/s10434-017-6059-0. PMID: 28831724
Positive predictive value for malignancy of pure flat epithelial atypia diagnosis by percutaneous needle biopsy of the breast: management of FEA in ultrasonography.
Maeda I, Kanemaki Y, Tozaki M, Koizumi H, Oana Y, Okanami Y, Tsuchiya K, Shimo A, Kojima Y, Hayami R, Nishikawa T, Kawamoto H, Yabuki Y, Tsugawa K, Takagi M
Breast Cancer 2015 Nov;22(6):634-40. Epub 2014 Apr 24 doi: 10.1007/s12282-014-0530-6. PMID: 24760612

Recent systematic reviews

Atypical ductal or lobular hyperplasia, lobular carcinoma in-situ, flat epithelial atypia, and future risk of developing breast cancer: Systematic review and meta-analysis.
Baker J, Noguchi N, Marinovich ML, Sprague BL, Salisbury E, Houssami N
Breast 2024 Dec;78:103807. Epub 2024 Sep 11 doi: 10.1016/j.breast.2024.103807. PMID: 39270543Free PMC Article
PATHOLOGIC FINDINGS IN GENDER-AFFIRMING MASTECTOMY: A SYSTEMATIC REVIEW.
Jahromi H, Horen S, Ho K, Tran E, Roth A, Schechter L
Georgian Med News 2022 Dec;(333):6-12. PMID: 36780614
The positive predictive value of vacuum assisted biopsy (VAB) in predicting final histological diagnosis for breast lesions of uncertain malignancy (B3 lesions): A systematic review & meta-analysis.
Cullinane C, Byrne J, Kelly L, O Sullivan M, Antony Corrigan M, Paul Redmond H
Eur J Surg Oncol 2022 Jul;48(7):1464-1474. Epub 2022 Apr 15 doi: 10.1016/j.ejso.2022.04.005. PMID: 35491362
Upgrade Rate of Pure Flat Epithelial Atypia Diagnosed at Core Needle Biopsy: A Systematic Review and Meta-Analysis.
Wahab RA, Lee SJ, Mulligan ME, Zhang B, Mahoney MC
Radiol Imaging Cancer 2021 Jan;3(1):e200116. Epub 2021 Jan 22 doi: 10.1148/rycan.2021200116. PMID: 33778758Free PMC Article
Flat Epithelial Atypia on Core Biopsy and Upgrade to Cancer: a Systematic Review and Meta-Analysis.
Rudin AV, Hoskin TL, Fahy A, Farrell AM, Nassar A, Ghosh K, Degnim AC
Ann Surg Oncol 2017 Nov;24(12):3549-3558. Epub 2017 Aug 22 doi: 10.1245/s10434-017-6059-0. PMID: 28831724

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