References
Schnitt SJ. WHO Classification of Tumours of the Breast, 4th edn. In Lakhani SR, Ellis IO, Schnitt SJ et al (eds) Lyon, France: International Agency for Research on Cancer 2012;87.
Schnitt SJ, Vincent-Salomon A. Columnar cell lesions of the breast. Adv Anat Pathol 2003;10:113–24.
Becker AK, Gordon PB, Harrison DA, et al. Flat ductal intraepithelial neoplasia 1A diagnosed at stereotactic core needle biopsy: is excisional biopsy indicated? AJR Am J Roentgenol 2013;200:682–8.
Martel M, Barron-Rodriguez P, Tolgay Ocal I, et al. Flat DIN 1 (flat epithelial atypia) on core needle biopsy: 63 cases identified retrospectively among 1,751 core biopsies performed over an 8-year period (1992–999). Virchows Arch 2007;451:883–91.
Kunju LP, Kleer CG. Significance of flat epithelial atypia on mammotome core needle biopsy: Should it be excised? Hum Pathol 2007;38:35–41.
Piubello Q, Parisi A, Eccher A, et al. Flat epithelial atypia on core needle biopsy: which is the right management? Am J Surg Pathol 2009;33:1078–4.
Abdel-Fatah TM, Powe DG, Hodi Z, et al. Morphologic and molecular evolutionary pathways of low nuclear grade invasive breast cancers and their putative precursor lesions: further evidence to support the concept of low nuclear grade breast neoplasia family. Am J Surg Pathol 2008;32:513–23.
Peres A, Barranger E, Becette V, et al. Rates of upgrade to malignancy for 271 cases of flat epithelial atypia (FEA) diagnosed by breast core biopsy. Breast Cancer Res Treat 2012;133:659–66.
Khoumais NA, Scaranelo AM, Moshonov H, et al. Incidence of breast cancer in patients with pure flat epithelial atypia diagnosed at core-needle biopsy of the breast. Ann Surg Oncol 2013;20:133–8.
Chivukula M, Bhargava R, Tseng G, Dabbs DJ. Clinicopathologic implications of “flat epithelial atypia” in core needle biopsy specimens of the breast. Am J Clin Pathol 2009;131:802–8.
Lavoue V, Roger CM, Poilblanc M et al. Pure flat epithelial atypia (DIN 1a) on core needle biopsy: study of 60 biopsies with follow-up surgical excision. Breast Cancer Res Treat 2011;125:121–6.
Sohn V, Porta R, Brown T. Flat epithelial atypia of the breast on core needle biopsy: an indication for surgical excision. Mil Med 2011;176:1347–50.
de Mascarel I, MacGrogan G, Mathoulin-Pelissier S, et al. Epithelial atypia in biopsies performed for microcalcifications. practical considerations about 2,833 serially sectioned surgical biopsies with a long follow-up. Virchows Arch 2007;451:1–10.
Bianchi S, Bendinelli B, Castellano I, et al. Morphological parameters of flat epithelial atypia (FEA) in stereotactic vacuum-assisted needle core biopsies do not predict the presence of malignancy on subsequent surgical excision. Virchows Arch 2012;461:405–17.
Uzoaru I, Morgan BR, Liu ZG, et al. Flat epithelial atypia with and without atypical ductal hyperplasia: to re-excise or not. Results of a 5-year prospective study. Virchows Arch 2012;461:419–23.
Ceugnart L, Doualliez V, Chauvet MP, et al. Pure flat epithelial atypia: is there a place for routine surgery? Diagn Interv Imaging 2013;94:861–9.
Villa A, Chiesa F, Massa T, et al. Flat epithelial atypia: comparison between 9-gauge and 11-gauge devices. Clin Breast Cancer 2013;13:450–4.
Dialani V, Venkataraman S, Frieling G, et al. Does isolated flat epithelial atypia on vacuum-assisted breast core biopsy require surgical excision? Breast J 2014;20:606–14.
Prowler VL, Joh JE, Acs G, et al. Surgical excision of pure flat epithelial atypia identified on core needle breast biopsy. Breast 2014;23:352–6.
Calhoun BC, Sobel A, White RL, et al. Management of flat epithelial atypia on breast core biopsy may be individualized based on correlation with imaging studies. Mod Pathol 2015;28:670–6.
Yu CC, Ueng SH, Cheung YC, et al. Predictors of underestimation of malignancy after image-guided core needle biopsy diagnosis of flat epithelial atypia or atypical ductal hyperplasia. Breast J 2015;21:224–32.
Berry JS, Trappey AF, Vreeland TJ, et al. Analysis of clinical and pathologic factors of pure, flat epithelial atypia on core needle biopsy to aid in the decision of excision or observation. J Cancer 2016;7:1–6.
Lee TY, Macintosh RF, Rayson D, Barnes PJ. Flat epithelial atypia on breast needle core biopsy: a retrospective study with clinical-pathological correlation. Breast J 2010;16:377–83.
Pinder SE, Reis-Filho JS. Non-operative breast pathology: columnar cell lesions. J Clin Pathol 2007;60:1307–12.
Said SM, Visscher DW, Nassar A, et al. Flat epithelial atypia and risk of breast cancer: a Mayo cohort study. Cancer 2015;121:1548–55.
Biggar MA, Kerr KM, Erzetich LM, Bennett IC. Columnar cell change with atypia (flat epithelial atypia) on breast core biopsy-outcomes following open excision. Breast J 2012;18:578–81.
Boulos FI, Dupont WD, Simpson JF, et al. Histologic associations and long-term cancer risk in columnar cell lesions of the breast: a retrospective cohort and a nested case-control study. Cancer 2008;113:2415–21.
Aroner SA, Collins LC, Schnitt SJ, et al. Columnar cell lesions and subsequent breast cancer risk: a nested case-control study. Breast Cancer Res 2010;12:R61.
Said SM, Rizzo W, Degnim AC, et al. Risk of developing breast cancer in patients with flat epithelial btypia (FEA) in benign breast biopsies. Mod Pathol 2014;27:79A.
Semb C. Pathologico-anatomical and clinical investigations of fibro-adenomatosis cystica mammae and its relation to other pathological conditions in th emamma, especially cancer. Acta Chir Scand Suppl 1928;10:1–484.
Fenoglio C, Lattes R. Sclerosing papillary proliferations in the female breast. A benign lesion often mistaken for carcinoma. Cancer 1974;33:691–700.
Fisher ER, Palekar AS, Kotwal N, Lipana N. A nonencapsulated sclerosing lesion of the breast. Am J Clin Pathol 1979;71:240–6.
Rickert RR, Kalisher L, Hutter RV. Indurative mastopathy: a benign sclerosing lesion of breast with elastosis which may simulate carcinoma. Cancer 1981;47:561–71.
Andersen JA, Gram JB. Radial scar in the female breast. A long-term follow-up study of 32 cases. Cancer 1984;53:2557–60.
Miller CL, West JA, Bettini AC, et al. Surgical excision of radial scars diagnosed by core biopsy may help predict future risk of breast cancer. Breast Cancer Res Treat 2014;145:331–8.
Conlon N, D’Arcy C, Kaplan JB, et al. Radial scar at image-guided needle biopsy: is excision necessary? Am J Surg Pathol 2015;39:779–85.
Douglas-Jones AG, Pace DP. Pathology of R4 spiculated lesions in the breast screening programme. Histopathology 1997;30:214–20.
Ciatto S, Morrone D, Catarzi S, et al. Radial scars of the breast: review of 38 consecutive mammographic diagnoses. Radiology 1993;187:757-60.
Hassell P, Klein-Parker H, Worth A, Poon P. Radial sclerosing lesions of the breast: mammographic and pathologic correlation. Can Assoc Radiol J 1999;50:370–5.
Kennedy M, Masterson AV, Kerin M, Flanagan F. Pathology and clinical relevance of radial scars: a review. J Clin Pathol 2003;56:721–4.
Philpotts LE, Shaheen NA, Jain KS, et al. Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology 2000;216:831–7.
Frouge C, Tristant H, Guinebretiere JM, et al. Mammographic lesions suggestive of radial scars: microscopic findings in 40 cases. Radiology 1995;195:623–5.
Sloane JP, Mayers MM. Carcinoma and atypical hyperplasia in radial scars and complex sclerosing lesions: importance of lesion size and patient age. Histopathology 1993;23:225–31.
Mooney KL, Bassett LW, Apple SK. Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review. Mod Pathol 2016;29:1471–84.
Li Z, Ranade A, Zhao C. Pathologic findings of follow-up surgical excision for radial scar on breast core needle biopsy. Hum Pathol 2016;48:76–80.
Leong RY, Kohli MK, Zeizafoun N, et al. Radial scar at percutaneous breast biopsy that does not require surgery. J Am Coll Surg 2016;223:712–6.
Kim EM, Hankins A, Cassity J, et al. Isolated radial scar diagnosis by core-needle biopsy: is surgical excision necessary? SpringerPlus 2016;5:398.
Matrai C, D’Alfonso TM, Pharmer L, et al. Advocating nonsurgical management of patients with small, incidental radial scars at the time of needle core biopsy: a study of 77 cases. Arch Pathol Lab Med 2015;139:1137–42.
Neal L, Sandhu NP, Hieken TJ, et al. Diagnosis and management of benign, atypical, and indeterminate breast lesions detected on core needle biopsy. Mayo Clin Proc 2014;89:536–47.
Nassar A, Conners AL, Celik B, et al. Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution. Ann Diagn Pathol 2015;19:24–8.
Brenner RJ, Jackman RJ, Parker SH, et al. Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? AJR Am J Roentgenol 2002;179:1179–84.
Linda A, Zuiani C, Furlan A, et al. Radial scars without atypia diagnosed at imaging-guided needle biopsy: how often is associated malignancy found at subsequent surgical excision, and do mammography and sonography predict which lesions are malignant? AJR Am J Roentgenol 2010;194:1146–51.
Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med 1985;312:146-51.
Hartmann LC, Sellers TA, Frost MH, et al. Benign breast disease and the risk of breast cancer. N Engl J Med 2005;353:229–37.
Berg JC, Visscher DW, Vierkant RA, et al. Breast cancer risk in women with radial scars in benign breast biopsies. Breast Cancer Res Treat 2008;108:167–74.
Nakhlis F, Ahmadiyeh N, Lester S, et al. Papilloma on core biopsy: excision vs. observation. Ann Surg Oncol 2015;22:1479–82.
Degnim AC, King TA. Surgical management of high-risk breast lesions. Surg Clin North Am 2013;93:329–40.
Collins LC, Schnitt SJ. Papillary lesions of the breast: selected diagnostic and management issues. Histopathology 2008;52:20–9.
Rizzo M, Lund MJ, Oprea G, et al. Surgical follow-up and clinical presentation of 142 breast papillary lesions diagnosed by ultrasound-guided core-needle biopsy. Ann Surg Oncol 2008;15:1040–7.
Gendler LS, Feldman SM, Balassanian R, et al. Association of breast cancer with papillary lesions identified at percutaneous image-guided breast biopsy. Am J Surg 2004;188:365–70.
Valdes EK, Tartter PI, Genelus-Dominique E, et al. Significance of papillary lesions at percutaneous breast biopsy. Ann Surg Oncol 2006;13:480–2.
Renshaw AA, Derhagopian RP, Tizol-Blanco DM, Gould EW. Papillomas and atypical papillomas in breast core needle biopsy specimens: risk of carcinoma in subsequent excision. Am J Clin Pathol 2004;122:217–21.
Sohn V, Keylock J, Arthurs Z, et al. Breast papillomas in the era of percutaneous needle biopsy. Ann Surg Oncol 2007;14:2979–84.
Chang JM, Han W, Moon WK, et al. Papillary lesions initially diagnosed at ultrasound-guided vacuum-assisted breast biopsy: rate of malignancy based on subsequent surgical excision. Ann Surg Oncol 2011;18:2506–14.
Swapp RE, Glazebrook KN, Jones KN, et al. Management of benign intraductal solitary papilloma diagnosed on core needle biopsy. Ann Surg Oncol 2013;20:1900–5.
Foley NM, Racz JM, Al-Hilli Z, et al. An international multicenter review of the malignancy rate of excised papillomatous breast lesions. Ann Surg Oncol 2015;22:S385–90.
Hawley JR, Lawther H, Erdal BS, et al. Outcomes of benign breast papillomas diagnosed at image-guided vacuum-assisted core needle biopsy. Clin Imaging 2015;39:576–81.
Wen X, Cheng W. Nonmalignant breast papillary lesions at core-needle biopsy: a meta-analysis of underestimation and influencing factors. Ann Surg Oncol 2013;20:94–101.
Pareja F, Corben AD, Brennan SB, et al. Breast intraductal papillomas without atypia in radiologic-pathologic concordant core-needle biopsies: rate of upgrade to carcinoma at excision. Cancer 2016;122:2819–27.
Tatarian T, Sokas C, Rufail M, et al. Intraductal papilloma with benign pathology on breast core biopsy: to excise or not? Ann Surg Oncol 2016;23:2501–7.
Hong YR, Song BJ, Jung SS, et al. Predictive factors for upgrading patients with benign breast papillary lesions using a core needle biopsy. J Breast Cancer 2016;19:410–16.
Carter CL, Corle DK, Micozzi MS, et al. A prospective study of the development of breast cancer in 16,692 women with benign breast disease. Am J Epidemiol 1988;128:467–77.
London SJ, Connolly JL, Schnitt SJ, Colditz GA. A prospective study of benign breast disease and the risk of breast cancer. JAMA 1992;267:941–4.
Lewis JT, Hartmann LC, Vierkant RA, et al. An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. Am J Surg Pathol 2006;30:665–72.
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Racz, J.M., Carter, J.M. & Degnim, A.C. Challenging Atypical Breast Lesions Including Flat Epithelial Atypia, Radial Scar, and Intraductal Papilloma. Ann Surg Oncol 24, 2842–2847 (2017). https://doi.org/10.1245/s10434-017-5980-6
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DOI: https://doi.org/10.1245/s10434-017-5980-6