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Atypical Epithelial Proliferation Evaluation: Risks and Management

In situations where atypia is noted but a diagnosis of FEA, ADH, or DCIS is precluded, close follow-up, re-core, or excision may be needed. Diagnostic reproducibility challenges exist due to poor interobserver agreement without standardized criteria. Variability is notable, particularly in distinguishing ADH vs. small volume LG DCIS. Concerns about accurate breast cancer risk assessment persist. Studies highlight the importance of using standardized criteria for consistent diagnosis.

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Atypical Epithelial Proliferation Evaluation: Risks and Management

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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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