Flat Epithelial Atypia

Question: I am a 53 year-old woman who gets yearly mammograms and my doctor told me I had some new “calcifications” and she wanted to biopsy them. My results showed “columnar cell change with atypia (flat epithelial atypia).” Now they say I need to have surgery to remove the area. I have looked this up and I don’t really understand what it means. Is this a pre-cancer?

Answer: Flat epithelial atypia is now the recommended term for a change in the ducts and lobules of the breast that used to be called a variety of things, including columnar cell change with atypia or CAPSS for example. We don’t know yet if this really is a precursor to cancer, but many studies have shown that when this finding is present in a core needle biopsy, many times there is a more significant finding on surgical excision, such as carcinoma in situ or even invasive carcinoma. Based on the research we have so far, most breast doctors are recommending removing the concerning area when a diagnosis like flat epithelial atypia is made by the pathologist.

3 Responses

  1. 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??

  2. 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.

  3. 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.

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