Focal Atypia

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brejim
brejim Member Posts: 39
edited June 2014 in High Risk for Breast Cancer
Focal Atypia
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  • brejim
    brejim Member Posts: 39
    edited February 2013

    My report from my Vacuum Asst biopsy says focal atypia? Is that the same as Atypical Ductal Hyperplasia or Lobular? I'm confused a little on that. It only says focal atypia associated with calcifications?

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  • ballet12
    ballet12 Member Posts: 981
    edited February 2013

    Hi Brejim,

    Focal does generally mean a small amount in one location.  It's most likely atypical ductal hyperplasia, but you are right, it could be atypical lobular hyperplasia (I've had both in one biopsy).  Are they planning to do a surgical biopsy?  The standard of practice is to proceed to a surgical biopsy.  Ask the radiologist (who conducted the vacuum asst. biopsy to clarify if it is ductal or lobular, and ask about the next step.)

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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited February 2013

    Focal atypia IS NOT the same as ADH or ALH unless that is specifically mentioned & I believe is considered a totally benign finding & usually requires no further follow up. You need to further discuss the finding with your doctor to better understand what this is. I do not believe they will recommend any further biopsy.

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  • leaf
    leaf Member Posts: 8,188
    edited February 2013

    I do not know for sure, but I am guessing that MelissaDallas is correct.  There are other types of atypia besides ADH and ALH.  It sounds like it might be a very, very early step - a nonobligate step - meaning it might be one of the very, very first of many steps that  most thing almost always stops right there and doesn't proceed towards anything worse.  It sounds like it does NOT have the same breast cancer risk as ADH or ALH.

    http://www.dslrf.org/mwh/content.asp?L2=2&L3=8&SID=132&CID=440&PID=16&CATID=4

    http://www.breast-cancer.ca/type/breast-columnar-cell-lesions.htm

    I agree that you need to talk to your doctor to better understand what this is.

    Pathologists can disagree about how a particular tissue is classified or diagnosed, particularly in these non-invasive cancer types.  Its normally easy to tell the difference between invasive breast cancer and normal, but it can be a more difficult call in cells that don't look ENTIRELY normal.

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  • Beesie
    Beesie Member Posts: 12,240
    edited February 2013

    I've pulled this quote from the link that leaf provided from Dr. Susan Love:

    "Focal atypia: This indicates that only a very small area of the total slides inspected was involved. Sometimes pathologists use this term as a way of hedging what is in fact a fairly subjective judgment, especially if the pathologist is not a specialist in breast pathology. It almost always means that the pathologist believes that this area is not very important overall."

    I agree that you should talk to your doctor about this, to see if he or she feels that there are any implications or anything further you should do. If your biopsy was done at a location that doesn't specialize in treating breast conditions, and if you are not comfortable with the findings, you may want to have the slides re-read by a different pathologist to get confirmation of the result. But overall I'd say that this result is probably nothing to be concerned about. We all have 'stuff' going on in our breasts, and most of it is harmless. If only a small portion of the breast tissue that was sampled showed any degree of atypia, it's unlikely that this is anything to worry about. But do talk to your doctor about it. 

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  • ballet12
    ballet12 Member Posts: 981
    edited February 2013

    Thanks, Melissa, for clarifying that "focal" atypia could be a very small amount of something that might not be ADH or ALH.  You are right that they would have specified it.  When discussing "atypia" doctors sometimes use that word in reference to ADH, such as "Did you have a finding of atypia?", but I guess atypia is not the same as ADH or ALH.

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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited February 2013

    Ballet, it is really hard to find much about it but seems it can even be a few fibro cells or irritation or something that resolves on its own.



    Sometimes I think because of the history most of us have we encourage or assume further biopsy or investigation is necessary when sometimes it is not:)

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  • ballet12
    ballet12 Member Posts: 981
    edited February 2013

    Yep,  all of this stuff starts someplace as a tiny amount of possibly "nothing" and most of the time it just stays that way or resolves.  Actually, as scary as it may seem, we all have the occasional "cancer" cells in various parts of the body, but if we have good tumor suppression genes, it goes nowhere.  As we get older, or if we have defects in those tumor suppressor genes (like the brca situation), or other known and unknown environmental factors enter the equation,  the pre-cancer cells can start dividing and then we may end up with something bigger or much bigger.  So it goes.

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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited February 2013

    Yeah, I've told the doctor it sure does seem like I'm trying hard to get cancer. My ovarian cancer was an adenoma-type, sclerosing adenosis in the breast, tubular adenoma colon polyps, LCIS...I think Adenoma shold be my middle name.

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  • brejim
    brejim Member Posts: 39
    edited February 2013

    I met with Breast surgeon at Dana Farber and she told me that it was up to me as far as having excisional biopsy. After discussing with her my options, I am going to do the 6 month mammo and see her again at that point and see what it looks like then. She did tell me it is pre cancer and a very small architechtural area of calcifications. I know before my core biopsy it was categorized as birads4b.

    In the meantime, she wants me to see the oncologist on 3/15. I will discuss with her exactly what it is. Thanks for all the good info!

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  • ballet12
    ballet12 Member Posts: 981
    edited February 2013

    Good luck.  You are in good hands at Dana Farber. It's interesting that it was a Birads 4b, so it clearly looked suspicious.  May the 6 months go quickly for you!

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  • brejim
    brejim Member Posts: 39
    edited March 2013

    Well I saw the oncologist today. She has suggested I don't do the wait and see in 6months. She did the computer charting (family history, etc)  and my numbers are 18% of having breast cancer in next 10 years so she suggested doing the exisional and we talked about tamoxefin.

    I was on the fence about the surgery as it was a small focal atypia but better to be safe than sorry.

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