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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2017

01-11-2017 | Breast Oncology

Flat Epithelial Atypia on Core Biopsy and Upgrade to Cancer: a Systematic Review and Meta-Analysis

Authors: Anatoliy V. Rudin, MD, Tanya L. Hoskin, MS, Aodhnait Fahy, BMBCh, Ann M. Farrell, MD, Aziza Nassar, MD, Karthik Ghosh, MD, Amy C. Degnim, MD

Published in: Annals of Surgical Oncology | Issue 12/2017

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Abstract

Background

No consensus exists on whether flat epithelial atypia (FEA) diagnosed percutaneously should be surgically excised. A systematic review and meta-analysis of the frequency of upgrade to cancer or an atypical ductal hyperplasia (ADH) at surgical excision of FEA was performed.

Methods

Embase, MEDLINE, Scopus, and Web of Science databases from January 2003 to November 2015 were searched. The inclusion criteria required a manuscript in English with original data on FEA diagnosed percutaneously, data including the presence or absence of other concurrent high-risk lesions, and data including outcome of cancer at surgical excision. Studies were assessed for quality, and two reviewers extracted data. Random-effects meta-analysis was used to pool estimates. The impact of study-level characteristics was assessed by stratified meta-analysis and meta-regression.

Results

The inclusion criteria was met by 32 studies. A total of 1966 core needle biopsies showed pure FEA, and 1517 (77%) showed surgical excision. The proportions of patients with upgrade to cancer varied from 0 to 42%, with an overall pooled estimate of 11.1%. Heterogeneity was observed, with the greatest impact based on whether a study included cases of FEA diagnosed before 2003. With restriction of the investigation to 16 higher-quality studies, the cancer upgrade pooled estimate was 7.5% (95% confidence interval [CI], 5.4–10.4%), and the rate of invasive cancer was 3% (95% CI 1.9–4.5%). For upgrade to ADH, data from 22 studies including 937 patients were analyzed. The proportion of patients upgraded to ADH ranged from 0 to 60%, with a pooled estimate of 17.9% overall and 18.6% among high-quality studies.

Conclusions

With patient management change potential for approximately 25% of patients, this analysis supports a general recommendation for surgical excision of FEA diagnosed by core biopsy.
Appendix
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Metadata
Title
Flat Epithelial Atypia on Core Biopsy and Upgrade to Cancer: a Systematic Review and Meta-Analysis
Authors
Anatoliy V. Rudin, MD
Tanya L. Hoskin, MS
Aodhnait Fahy, BMBCh
Ann M. Farrell, MD
Aziza Nassar, MD
Karthik Ghosh, MD
Amy C. Degnim, MD
Publication date
01-11-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6059-0

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