Flat epithelial atypia

[braveheart2]

My recent pathology report after a stereotactic core needle biopsy for a new cluster of microcalcifications reads: proliferative fibrocystic changes with adenosis, apocrine metaplasia, and columnar cell alteration with focal flat epithelial atypia (FEA). I am told the FEA is the most worrisome finding, and am scheduled for a wire-guided excisional biopsy next week although my MD assures me that "anything bad would be in the earliest of stages."

What causes FEA? Is it always considered pre-cancerous and/or found adjacent to existing cancer? Is there a chance I can still come away with a benign diagnosis? Thank you for your input!

[Cleveland Clinic]

Dear braveheart2:  Flat epithelial atypia is a term that describes the epithelial cells lining the ducts, which are usually columnar in shape and which display low-grade cytologic atypia. Observational studies have suggested that at least some of these lesions may represent a precursor of ductal carcinoma in situ (DCIS). The limited available clinical follow-up data suggest that the risk of both local recurrence and progression of these lesions to invasive cancer is extremely low.  Treating these as DCIS may result in overtreatment of many patients. Additional studies are needed to better understand the biological nature and clinical significance of these lesions.  In general, an excisional biopsy is recommended to be sure that there is no actual DCIS or invasive cancer.

[braveheart2]

Thank you for the detailed explanation! I will post the pathology findings from my excisional biopsy next week to let you know the outcome.