Eg Very few cells fragmented specimen only in lobules May use something along the lines of Epithelial proliferation with atypia see comment Results in close followup recore excision depending on clinicalradiographic setting ID: 931626
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Slide1
Slide2Slide3Slide4Practical 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.
Slide5Slide6Slide7Slide8CCC
FEA
Slide9Risks and management
UDH
ADH
LG DCIS
FEA
RR of IDC
1.5x
3-5x
8-10x
Less than ADH
Upgrade rate to DCIS on excision
N/A
15-50%*
N/A
25-40% **
ManagementNilExciseExcise +/- radiationExciseType of riskIndicator, bilateralIndicator, bilateralPrecursorIndicator
** Limited data and wide variation in reported upgrade rate.
* 3 or more foci on core biopsy and micropapillary architecture predict greater risk.
Slide10Diagnostic 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.
Slide11Diagnostic reproducibility
Jain et al. Mod Pathol 2011 Jul;24(7):917-23.