[221] Radiological and Pathological Extent of Columnar Cell Changes with Atypia (CCC-A) Diagnosed on Core Needle Biopsy (CNB) Correlates with Carcinoma Upgrade on Surgical Excision (SE)

Fang-I Lu, Dilip Giri. Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Memorial Sloan-Kettering Cancer Centre, New York, NY

Background: The management of pure CCC-A (i.e. flat epithelial atypia) diagnosed on CNB continues to be problematic, with the current management consisting of SE to exclude coexisting ductal carcinoma in-situ (DCIS) and invasive carcinoma (IC). This study was designed to identify clinical, radiological and pathological features of CCC-A diagnosed on CNB that correlated with carcinoma upgrade on SE.
Design: We identified all CNB performed at our institution and signed out as CCC-A between January 1, 2006 and October 31, 2011. Only cases diagnosed as pure CCC-A by 2 breast pathologists were included in this study. Clinical, radiological and pathological features on CNB (see table) were evaluated blinded to the diagnoses on SE. Two-tail t-test was used to identify features that were significantly different between CCC-A cases with and without carcinoma upgrade.

Features of Columnar Cell Changes with Atypia (CCC-A) on Core Needle Biopsy Evaluated
Clinical featuresAge at diagnosis, menopausal status, personal &family history of breast cancer, hormone replacement therapy &tamoxifen use
Radiological featuresReason for biopsy (bx), bx modality, BI-RAD score, gauge of the bx needle, size, number (#) of cores bx, # of cores with calcification
Pathological features# of cores with CCC-A, # of cores bx, number of terminal ducto-lobular units (TDLU) with CCC-A, size of CCC-A, calcification in &outside of CCC-A, morphology of CCC-A (dilated rigid TDLU, loss of polarity, indistinct myoepithelial layer, nuclear enlargement, round nuclei, nuclear pleomorphism, nuclear hyperchromasia, vesicular chromatin, prominent nucleoli, mitosis, necrosis)

Results: Thirty-four cases were diagnosed as pure CCC-A on pathology review. All of these cases underwent SE. On SE, 4 of the 34 (11.8%) cases upgraded to carcinoma, with 1 to IC and 3 to DCIS. Of the CNB features of CCC-A evaluated, only radiological size (26 mm vs 9 mm, p=0.03117), pathological size (7.4 mm vs 2.5 mm, p=0.000006) and number of terminal ducto-lobular units (TDLU) involved (7.3 TDLU vs 2.5 TDLU, p=0.00065) were significantly different between CCC-A cases with and without carcinoma upgrade.
Conclusions: In this study, 34 cases of pure CCC-A diagnosed on CNB were identified, with 4 (11.8%) upgraded to either IC or DCIS on SE. Radiological size, pathological size and number of TDLU involved were the only CNB features of CCC-A found to correlate with carcinoma upgrade on SE.
Category: Breast

Monday, March 4, 2013 1:00 PM

Poster Session II # 39, Monday Afternoon


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