Clinicopathologic Characteristics of Carcinomas That Develop after a Biopsy Containing Columnar Cell Lesions
JF Simpson, FI Boulos, WD Dupont, DL Page, ME Sanders. Vanderbilt University Medical Center, Nashville, TN; American University, Beirut, Lebanon
Background: Columnar cell lesions (CCL) of the breast are frequently detected mammographically because they often contain calcification. Because of their frequent association with atypical ductal hyperplasia, lobular neoplasia, and tubular carcinoma, they have been suggested as a precursor lesion for low grade carcinomas. However, in long term follow-up studies, CCL are associated with only a slight increase in later breast cancer development (Boulos et al. Cancer 113:2415-21, 2008). If CCLs are precursor lesions, we would expect subsequent cancers to develop in the same site as the biopsy. Moreover, we would expect the subsequent carcinomas to be of low grade. Our goal was to review the clinical and pathologic features of carcinomas that develop after a diagnosis of CCL to try to establish these lesions as precursors to invasive carcinoma.
Design: From the Nashville Breast Cohort, 1261 biopsies were identified that contained CCL; these formed the basis of a nested case control study. CCL were defined using the criteria of Schnitt and Vincent-Salomon (Adv Anat Pathol 10:113-24, 2003). In follow up of an average of 17 years, 77 women developed invasive carcinoma, compared to 152 controls who did not develop invasive carcinoma. The clinical and pathologic features of the cancers that developed form the basis of this study.
Results: CCL were more likely to be associated with atypical ductal hyperplasia, (ADH) at the time of original biopsy, although the presence of CCL did not increase the risk over that of ADH alone. The average age at diagnosis of invasive carcinoma was 63 years. The majority of invasive carcinomas that developed were of no special type, and were of intermediate combined histologic grade. Moreover, the carcinomas that developed were as likely to occur in the contralateral breast as in the breast that was originally diagnosed with CCL.
Conclusions: There is a favored association of CCL with atypical ductal hyperplasia. Subsequent carcinoma development is uncommon, and may occur in either breast. The development of intermediate grade carcinomas of no special type, argues against CCL being an obligate precursor lesion for invasive carcinomas.
Monday, March 22, 2010 9:00 AM
Platform Session: Section C, Monday Morning