1. Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

2. The limited available data suggest that when atypia is encountered in a core needle biopsy specimen, subsequent excision shows a more advanced lesion in about 1/3 of cases. This is sufficiently frequent to recommend excision in such cases as a matter of routine Breast Cancer Res 2003; 5:263-268 Clinical problems: to excise or not to excise CCC?

3. Margin evaluation: CCL with atypia should not be taken into consideration even when they are composed of cells that are cytologically similar to those in the diagnostic areas of clinging DCIS. Advances in Anatomic Pathology 2003; 10: 113-124

4. FEA/ADH/CDIS/DIN??????????????????????????????

5. Virchows Arch (2007) 451:883–891 The term “flat” refers to the overall architecture of the proliferation, which lacks any intraluminal protrusions in the form of arcades, bridges, or micropapillae and is essential in distinguishing this lesion from ADH.

7. ADH DIN1B FEA DIN1A

9. Modern Pathology (2009) 1–8

13. Histology at surgery RX-FU (months) N° Benign Atypia (LIN/ADH/FEA) Mal (DCIS/IC) mean 38 ± 6.8 B2 CCL without atypia685(7%)63 (93%) B3 FEA3813 (34%)20 (53%)5 (13%) CCL without atypia and Papilloma 11 (100%) CCL without atypia or FEA with LIN 112 (18%)5 (45%)1 (9%)3 (27%) CCL without atypia or FEA with ADH 21 (50%) B4 Extensive FEA31 (33%)2 (67%)

14. 2. Multidisciplinary approach for FEA managing 3. Surgery recommended when CCL without atypia or FEA are associated with other risk lesions (ADH/LIN) on VACB; 4. Excision biopsy not mandatory only when histopathological findings are concordant with the radiological features and flat epithelial atypia is found on VACB as the most advanced lesion. Management CCL/FEA 1. CCL without atypia BENIGN

15. FOLLOW UP?

16. close followup is advised with repeat mammogram every 6 months for 2–3 years for early detection of any such invasive carcinomas in the vicinity of flat DIN 1. Virchows Arch (2007) 451:883–891

17. 1. Multidisciplinary approach 2. Surgery recommended when CCL without atypia or FEA are associated with other risk lesions (ADH/LIN) on VACB; 3. Excision biopsy not mandatory only when histopathological findings are concordant with the radiological features and flat epithelial atypia is found on VACB as the most advanced lesion. 4. women should be advised of the possible hormone dependency of CCLs. Management CCL/FEA

18. 3D reconstruction of an atypical cystic lobule ER(red) and Ki67(green) in CCL

19. Laboratory Investigation (2008) 88, 938–948

20. CCL Not CCL