Flat epithelial atypia (FEA) is an emerging entity of uncertain clinical significance, and outcome data are sparse. The aim of this study was to evaluate the clinicopathologic significance of this entity for proper management. All core needle biopsy (CNB) specimens diagnosed as atypical ductal hyperplasia (ADH) from January 2006 to April 2008 were retrieved. H&E-stained slides of 5 levels on each case were reviewed. The differences in upstaging in subsequent excisions in the FEA and ADH group (31/189 [16.4%]) vs the pure FEA group (5/35 [14%]) and pure FEA (5/35 [14%]) vs pure ADH (5/45 [11%]) were not statistically significant. We observed that FEA evolved into ADH at the same site at an average of 3 to 4 levels. Our study concludes that there is an association of FEA with ADH on multiple levels of CNB specimens, and follow-up surgical excision findings for FEA are clinically significant.