Flat Epithelial Atypia on Core Biopsy and Upgrade to Cancer

a Systematic Review and Meta-Analysis

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

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Aug 22 2017

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Meta-Analysis
Carcinoma, Intraductal, Noninfiltrating
Biopsy
Neoplasms
Confidence Intervals
Large-Core Needle Biopsy
Manuscripts
MEDLINE
Databases

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Flat Epithelial Atypia on Core Biopsy and Upgrade to Cancer : a Systematic Review and Meta-Analysis. / Rudin, Anatoliy V.; Hoskin, Tanya L.; Fahy, Aodhnait; Farrell, Ann M.; Nassar, Aziza; Ghosh, Karthik; Degnim, Amy C.

In: Annals of Surgical Oncology, 22.08.2017, p. 1-10.

Research output: Contribution to journalArticle

Rudin, Anatoliy V. ; Hoskin, Tanya L. ; Fahy, Aodhnait ; Farrell, Ann M. ; Nassar, Aziza ; Ghosh, Karthik ; Degnim, Amy C. / Flat Epithelial Atypia on Core Biopsy and Upgrade to Cancer : a Systematic Review and Meta-Analysis. In: Annals of Surgical Oncology. 2017 ; pp. 1-10.
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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.",
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AU - Ghosh, Karthik

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AB - 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.

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