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Epithelial Atypia in Breast Lesions: Clinical Impact and Management Strategies

Explore the complexities of identifying atypical breast lesions with factors such as limited specimen, atypical cells, and diagnostic challenges. Learn about the risks, diagnostic reproducibility issues, and recommended management strategies for optimal patient care.

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Epithelial Atypia in Breast Lesions: Clinical Impact and Management Strategies

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  1. Practical point • There are some situations where atypia is noted, but other factors preclude a diagnosis of FEA, ADH, or DCIS. • E.g. Very few cells, fragmented specimen, only in lobules. • May use something along the lines of: • Epithelial proliferation with atypia, see comment. • Results in close follow-up, re-core, excision, depending on clinical/radiographic setting.

  2. CCC FEA

  3. Risks and management * 3 or more foci on core biopsy and micropapillary architecture predict greater risk. ** Limited data and wide variation in reported upgrade rate.

  4. Diagnostic reproducibility • Multiple studies have indicated that interobserver agreement is poor, particularly when standardized criteria are not used. • Most variability among ADH vs small volume LG DCIS • In one study, diagnostic consistency was not significantly better when interpretation was confined to a single image, rather than the whole slide(s), reflecting inconsistencies in morphological interpretation • ?Concerns re accurate risk of breast ca development because of this Elston et al. Eur J Cancer 2000; 36: 1769-72.

  5. Diagnostic reproducibility Jain et al. Mod Pathol 2011 Jul;24(7):917-23.

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