Columnar Cell Lesions Diagnosed by Core Needle Biopsy of the Breast: Correlation with Surgical Excision
CJ Sailey, DGK Phillips, J Warner, OB Ioffe. Univ of Maryland, Baltimore, MD
Background: Columnar cell lesions (CCLs) of the breast have been gaining attention as potential nonobligate precursor or even an earliest recognizable form of low-grade intraductal and some invasive carcinomas. However, there is no consensus on management of these lesions diagnosed on percutaneous imaging-guided core needle biopsy (CNB).
Design: We have retrospectively reviewed CNBs with less than malignant diagnosis dating from 1997 to 2008 which had a subsequent excision. This review identified 59 CNBs with CCLs in 57 women (age 34-85, average 56.3). We used the morphologic schema by Schnitt to classify these lesions into columnar cell change (CCC), columnar cell hyperplasia (CCH), and flat epithelial atypia (FEA) which comprises CCC and CCH with atypia. 47 (80%) lesions presented with microcalcifications and were biopsied under stereotactic guidance using 11g vacuum-assisted probe; 12 (20%) presented as a mass and were biopsied under ultrasound guidance with a 14g needle.
Results: 11 of 59 (19%) cases were upgraded to malignant on excision, including one invasive mucinous carcinoma presenting as a mass; the remainder were low-grade DCIS.
|Feature on CNB||Malignancy on Excision/Total Number of Cases||p|
|ducts with CCL|
|CCC/CCH||2/14 (14%), 1 invasive mucinous||NS|
|CCL with ADH||4/26 (15%)||NS|
|FEA with ADH||3/23 (13%)||NS|
|CCL with mucocele||0/11 (0%)||NS|
|CCL with lobular neoplasia||1/6 (16%)||NS|
|CCL with radial scar||0/3 (0%)||NS|
Conclusions: To the best of our knowledge, this is the largest study of surgical follow-up of CCLs diagnosed on CNB. The rate of upgrade to malignancy was slightly higher for FEA than for non-atypical CCL. ADH, lobular neoplasia and mucocele did not increase the likelihood of upgrade. The only features predictive of malignancy on excision were presentation as a mass and FEA. Excision should be recommended for FEA with or without ADH or lobular neoplasia. Consideration should be given to excision of masses showing any CCL on CNB.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 46, Monday Morning