Flat epithelial atypia is a common subtype of B3 breast lesions and is associated with noninvasive cancer but not with invasive cancer in final excision histology

Noske, Aurelia; Pahl, Stefan; Fallenberg, Eva; Richter-Ehrenstein, Christiane; Buckendahl, Ann-Christin; Weichert, Wilko; Schneider, Achim; Dietel, Manfred; Denkert, Carsten

doi:10.1016/j.humpath.2009.09.005

« Previous Next »Human Pathology
Volume 41, Issue 4 , Pages 522-527, April 2010

Flat epithelial atypia is a common subtype of B3 breast lesions and is associated with noninvasive cancer but not with invasive cancer in final excision histology

Aurelia Noske, MD
- Institute of Pathology, Universitätsmedizin Charité Berlin, 10117 Berlin, Germany
- Corresponding author.
Stefan Pahl, MD
- Institute of Pathology, Universitätsmedizin Charité Berlin, 10117 Berlin, Germany
Eva Fallenberg, MD
- Institute of Radiology, Universitätsmedizin Charité Berlin, 10117 Berlin, Germany
Christiane Richter-Ehrenstein, MD
- Department of Gynaecology and Obstetrics, Universitätsmedizin Charité Berlin, 10117 Berlin, Germany
Ann-Christin Buckendahl, MD
- Institute of Pathology, Universitätsmedizin Charité Berlin, 10117 Berlin, Germany
Wilko Weichert, MD
- Institute of Pathology, Universitätsmedizin Charité Berlin, 10117 Berlin, Germany
Achim Schneider, MD
- Department of Gynaecology and Obstetrics, Universitätsmedizin Charité Berlin, 10117 Berlin, Germany
Manfred Dietel, MD
- Institute of Pathology, Universitätsmedizin Charité Berlin, 10117 Berlin, Germany
Carsten Denkert, MD
- Institute of Pathology, Universitätsmedizin Charité Berlin, 10117 Berlin, Germany

Received 1 July 2009; received in revised form 11 September 2009; accepted 11 September 2009. published online 11 December 2009.

Summary

The biological behavior and the optimal management of benign breast lesions with uncertain malignant potential, the so-called B3 lesions, found in breast needle core biopsies is still under debate. We addressed this study to compare histologic findings in B3 needle core biopsies with final excision specimens to determine associated rates of malignancy. Consecutive needle core biopsies were performed in a 3-year period (January 1, 2006-December 31, 2008). Biopsies were image-guided (31 by ultrasound, 85 stereotactic vacuum-assisted, 6 unknown) for evaluation of breast abnormalities. We reviewed 122 needle core biopsies with B3 lesions of 91 symptomatic patients and 31 screen-detected women and compared the B3 histologic subtypes with the final excision histology. A total of 1845 needle core biopsies were performed and B3 lesions comprised 6.6% of all B categories. The most common histologic subtype in biopsies was flat epithelia atypia in 35.2%, followed by papillary lesions in 21% and atypical ductal hyperplasia in 20%. Reports on excision specimens were available in 66% (81 patients). Final excision histology was benign in 73 (90.2%) and malignant in 8 (9.8%) patients (2 invasive cancer, 6 ductal carcinoma in situ). Of all B3 subtypes, atypical ductal hyperplasia and flat epithelial atypia were associated with malignancy, whereas only atypical ductal hyperplasia was accompanied by invasive cancer. Of all lesions, flat epithelial atypia was most frequently found in excision specimens (18%). In our study, flat epithelial atypia and atypical ductal hyperplasia are common lesions of the B3 category in needle core biopsies of the breast. Both lesions are associated with malignancy, whereas only atypical ductal hyperplasia was related to invasive cancer. We conclude that an excision biopsy after diagnosis of flat epithelial atypia is recommended depending on clinical and radiologic findings.

Keywords: Needle core biopsy, Breast, B-classification, FEA, ADH