Comments on: Flat Epithelial Atypia http://www.pacificbreastpathology.com/blog/ask_the_pathologist/flat-epithelial-atypia/ Pacific Breast Pathology weblog Thu, 12 Jan 2012 21:28:04 -0800 http://wordpress.org/?v=2.9.2 hourly 1 By: susan http://www.pacificbreastpathology.com/blog/ask_the_pathologist/flat-epithelial-atypia/comment-page-1/#comment-15090 susan Wed, 04 Jan 2012 22:53:16 +0000 http://www.breastpathologyconsults.com/blog/?p=181#comment-15090 this is the diagnose on my left breast: # satisfactory. adequate sample # benign # cellular findings consistent with a fibroadenoma this is the diagnose on my right breast # cellular finding consistent with a proliferative breast lesion with atypia remarks: due to the size of the mass and the small size from a limited area obtained through FNAB., tissue biopsy is suggested. this is the diagnose on my left breast:
# satisfactory. adequate sample
# benign
# cellular findings consistent with a fibroadenoma
this is the diagnose on my right breast
# cellular finding consistent with a proliferative breast lesion with atypia
remarks:
due to the size of the mass and the small size from a limited area obtained through FNAB., tissue biopsy is suggested.

]]> By: drlawton http://www.pacificbreastpathology.com/blog/ask_the_pathologist/flat-epithelial-atypia/comment-page-1/#comment-5211 drlawton Tue, 08 Mar 2011 18:02:32 +0000 http://www.breastpathologyconsults.com/blog/?p=181#comment-5211 I reviewed the literature on FEA with a colleague of mine from Harvard Medical School and we wrote a book chapter which was just published in Radiologic Clinics of North America. We actually found that the literature is conflicted as to the need for surgical biopsy after a core needle diagnosis of FEA. I am not convinced, based on the literature, that all FEA on core biopsy needs to be surgically excised. I am not aware of doctors giving Tamoxifen to patients when the diagnosis is FEA alone. I reviewed the literature on FEA with a colleague of mine from Harvard Medical School and we wrote a book chapter which was just published in Radiologic Clinics of North America. We actually found that the literature is conflicted as to the need for surgical biopsy after a core needle diagnosis of FEA. I am not convinced, based on the literature, that all FEA on core biopsy needs to be surgically excised.

I am not aware of doctors giving Tamoxifen to patients when the diagnosis is FEA alone.

]]> By: Ed Klein MD http://www.pacificbreastpathology.com/blog/ask_the_pathologist/flat-epithelial-atypia/comment-page-1/#comment-4305 Ed Klein MD Thu, 03 Feb 2011 17:38:22 +0000 http://www.breastpathologyconsults.com/blog/?p=181#comment-4305 There is abundant pathologic evidence of strong association between flat epithelial atypia and some types of low grade breast cancer (low grade DCIS, invasive tubular carcinoma and non-invasive lobular neoplasia-ALH, LCIS) in the same breast tissue where FEA is idenfied on biopsy. This alone warrants managing women with FEA as having slightly increased risk for breast cancer in general. The published risk value is 1.5 - 2 fold, compared to 5 fold increased risk for ADH or ALH. When FEA is diagnosed on a needle or core biopsy the current recommendation is to conservatively remove the breast tissue surrounding the biopsy site containing the FEA. Moreover, these atypical columnar cells have been found to contain some of the chromosomal abnormalities often seen in cells composing some low grade breast cancers (low grade DCIS, tubular carcinoma). As such, FEA is a 'premalignant' condition, but AT THIS POINT does not appear to have quite the same risk as atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH). A question our surgeons ask is whether Tamoxifen therapy is indicated when FEA is the only risk factor found in a breast excisional biopsy. Any thoughts?? There is abundant pathologic evidence of strong association between flat epithelial atypia and some types of low grade breast cancer (low grade DCIS, invasive tubular carcinoma and non-invasive lobular neoplasia-ALH, LCIS) in the same breast tissue where FEA is idenfied on biopsy. This alone warrants managing women with FEA as having slightly increased risk for breast cancer in general. The published risk value is 1.5 – 2 fold, compared to 5 fold increased risk for ADH or ALH. When FEA is diagnosed on a needle or core biopsy the current recommendation is to conservatively remove the breast tissue surrounding the biopsy site containing the FEA. Moreover, these atypical columnar cells have been found to contain some of the chromosomal abnormalities often seen in cells composing some low grade breast cancers (low grade DCIS, tubular carcinoma). As such, FEA is a ‘premalignant’ condition, but AT THIS POINT does not appear to have quite the same risk as atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH).
A question our surgeons ask is whether Tamoxifen therapy is indicated when FEA is the only risk factor found in a breast excisional biopsy. Any thoughts??

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