Positive predictive value for malignancy of pure flat epithelial atypia diagnosis by percutaneous needle biopsy of the breast: management of FEA in ultrasonography

• Published in: Breast Cancer Vol. 22; no. 6; pp. 634 - 640
• Main Authors: Maeda, Ichiro, Kanemaki, Yoshihide, Tozaki, Mitsuhiro, Koizumi, Hirotaka, Oana, Yoshiyasu, Okanami, Yuko, Tsuchiya, Kyoko, Shimo, Arata, Kojima, Yasuyuki, Hayami, Ryousuke, Nishikawa, Toru, Kawamoto, Hisanori, Yabuki, Yukari, Tsugawa, Koichiro, Takagi, Masayuki
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Science and Business Media LLC 01.11.2015; Springer Japan; Springer
• Subjects: Adult; Biopsy, Needle; Biopsy, Needle - methods; Breast; Breast - pathology; Breast Neoplasms; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Cancer Research; Carcinoma, Ductal; Carcinoma, Intraductal, Noninfiltrating; Carcinoma, Intraductal, Noninfiltrating - diagnostic imaging; Carcinoma, Intraductal, Noninfiltrating - pathology; Diagnosis; Diagnostic imaging; Epithelial Cells; Epithelial Cells - pathology; Female; Humans; Hyperplasia; Hyperplasia - pathology; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Oncology; Original Article; Surgery; Surgical Oncology; Ultrasonography, Mammary; Ultrasound imaging; Flat epithelial atypia; Breast; Columnar cell hyperplasia; Biopsy; DCIS
• ISSN: 1340-6868; 1880-4233; 1880-4233
• DOI: 10.1007/s12282-014-0530-6

Background Some reports suggest that the rate of definitive diagnosis of malignant tumors, namely, the final diagnosis being revised to a higher stage, in patients diagnosed as having flat epithelial atypia (FEA) by percutaneous needle biopsy of the breast (PNB) is as low as 0–3 %. However, other reports suggest that the rate is as high as 10 % or more, bringing confusion on this issue. We examined the positive predictive value for malignancy in the patients diagnosed as having pure FEA and the patients’ radiolopathological characteristics observed in our hospital. Methods Of the patients who underwent PNB in our facility, those who were diagnosed as having pure FEA were recruited as the subjects of this study. Results Of the 4,197 consecutive patients who underwent PNB, 44 (1.0 %) were diagnosed as having pure FEA following a re-examination. Among 44 cases, 39 cases were selected as the subjects of this study. Among the 39 patients, six patients were diagnosed as having malignant lesions, two of whom had invasive carcinoma of no special type (papillotubular type), one had tubular carcinoma, one had ductal carcinoma in situ (DCIS) of high nuclear grade, one had DCIS of intermediate nuclear grade, and one had DCIS of low nuclear grade. The diameters of 6 malignant lesions were 10–30 mm at ultrasonography (US) examination. Five of the 39 patients had contralateral breast cancer. Conclusion The positive predictive value for malignancy of pure FEA was 15.7 %. The patients with pure FEA may make a follow up without an excisional biopsy when the lesion sizes less than 10 mm on US examination.