{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T13:19:42Z","timestamp":1761311982899,"version":"3.37.3"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,7,22]],"date-time":"2023-07-22T00:00:00Z","timestamp":1689984000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30 CA016672"],"award-info":[{"award-number":["P30 CA016672"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To compare flat epithelial atypia (FEA) upgrade rates after excision versus surveillance and to identify variables associated with upgrade.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This single-institution retrospective study identified isolated FEA cases determined by percutaneous biopsy from April 2005 through July 2022 with excision or \u22652 years surveillance. All cases were recommended for excision or surveillance based on multidisciplinary discussion of clinical, imaging, and pathologic variables with emphasis on sampling adequacy and significant atypia. Truth was determined by pathology at excision or the absence of cancer on surveillance. Upgrade was defined as cancer occurring \u22642 cm from the biopsy site. Demographic, imaging, and biopsy variables were compared between those that did and did not upgrade.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 112 cases of isolated FEA, imaging findings included calcifications in 81.3% (91\/112), MRI lesions in 11.6% (13\/112), and distortions or masses in 7.1% (8\/112). Excision was recommended in 12.5% (14\/112) and surveillance in 87.5% (98\/112) of cases. Among those recommended for excision, 28.6% (4\/14) of cases were upgraded, all to ductal carcinoma in situ. In those recommended for surveillance, 1.0% (1\/98) were upgraded to invasive cancer. Overall, FEA had a 4.5% (5\/112) upgrade rate, and 2.7% (3\/112) also developed cancer &amp;gt;2 cm from the FEA. There were no significant differences in demographic, imaging, and biopsy variables between those that did and did not upgrade to cancer.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Multidisciplinary management of isolated FEA distinguishes those at higher risk of upgrade to cancer (28.6%) in whom surgery is warranted from those at low risk of upgrade (1.0%) who can be managed non-operatively.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jbi\/wbad049","type":"journal-article","created":{"date-parts":[[2023,7,23]],"date-time":"2023-07-23T01:55:55Z","timestamp":1690077355000},"page":"575-584","source":"Crossref","is-referenced-by-count":1,"title":["Isolated Flat Epithelial Atypia: Upgrade Outcomes After Multidisciplinary Review\u2013Based Management Using Excision or Imaging Surveillance"],"prefix":"10.1093","volume":"5","author":[{"given":"Charlies L","family":"Xie","sequence":"first","affiliation":[{"name":"MD Anderson Cancer Center, Department of Breast Imaging , Houston, TX , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary J","family":"Whitman","sequence":"additional","affiliation":[{"name":"MD Anderson Cancer Center, Department of Breast Imaging , Houston, TX , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lavinia P","family":"Middleton","sequence":"additional","affiliation":[{"name":"MD Anderson Cancer Center, Department of Pathology , Houston, TX , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Therese B","family":"Bevers","sequence":"additional","affiliation":[{"name":"MD Anderson Cancer Center, Department of Clinical Cancer Prevention , Houston, TX , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabelle","family":"Bedrosian","sequence":"additional","affiliation":[{"name":"MD Anderson Cancer Center, Department of Breast Surgical Oncology , Houston, TX , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0135-8402","authenticated-orcid":false,"given":"Hannah L","family":"Chung","sequence":"additional","affiliation":[{"name":"MD Anderson Cancer Center, Department of Breast Imaging , Houston, TX , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,7,22]]},"reference":[{"issue":"2","key":"2023092301533369000_CIT0001","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1111\/his.14091","article-title":"The 2019 World Health Organization classification of tumours of the breast","volume":"77","author":"Tan","year":"2020","journal-title":"Histopathology"},{"issue":"10","key":"2023092301533369000_CIT0002","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1002\/cncr.29243","article-title":"Flat epithelial atypia and risk of breast cancer: a Mayo cohort study","volume":"121","author":"Said","year":"2015","journal-title":"Cancer"},{"issue":"8","key":"2023092301533369000_CIT0003","doi-asserted-by":"crossref","first-page":"653.e19","DOI":"10.1016\/j.crad.2019.04.006","article-title":"An audit of mammographic screen detected lesions of uncertain malignant potential (B3) diagnosed on initial image guided needle biopsy: how has our practice changed over 10 years","volume":"74","author":"Batohi","year":"2019","journal-title":"Clin Radiol"},{"volume-title":"ACR BI-RADS\n              \u00ae\n            Atlas, Breast Imaging Reporting and Data System","year":"2013","author":"D\u2019Orsi","key":"2023092301533369000_CIT0004"},{"issue":"8","key":"2023092301533369000_CIT0005","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1097\/PAS.0b013e31825f9d6a","article-title":"Transitions between flat epithelial atypia and low-grade ductal carcinoma in situ of the breast","volume":"36","author":"Aulmann","year":"2012","journal-title":"Am J Surg Pathol"},{"issue":"2","key":"2023092301533369000_CIT0006","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/SLA.0b013e318233523f","article-title":"Columnar cell lesions on breast needle biopsies: is surgical excision necessary? 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