Columnar cell lesions associated with breast calcifications on vacuum-assisted core biopsies: clinical, radiographic, and histological correlations

Senetta, Rebecca; Campanino, Pier Paolo; Mariscotti, Giovanna; Garberoglio, Sara; Lilleri, Daniele; Pennecchi, Francesca; Macrì, Luigia; Bosco, Martino; Gandini, Giovanni; Sapino, Anna

doi:10.1038/modpathol.2009.21

Cited by 60 publications

(43 citation statements)

References 26 publications

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“…In the present study, flat epithelial atypia was never associated with cancer at excision, and this result is the same in Senetta et al' series 15 of 38 flat epithelial atypia. Jara-Lazaro et al 16 report from small population groups the presence of ductal carcinoma and lobular neoplasias in excision biopsies for up to 22 and 36% of core biopsies with pure flat epithelial atypia.…”

Section: Criteria In the Literature On Which To Decide Whether Or Notsupporting

confidence: 91%

“…In Senetta et al's study, 15 BI-RADS5 lesions were never associated with flat epithelial atypia (5/24 in our series). This result raises the problem of interobserver reproducibility in the classification of radiological calcifications.…”

Section: Interobserver Reproducibility In the Classification Of Radiocontrasting

confidence: 39%

“…This is why we individualized atypical ductal hyperplasia with micropapillary architecture in the group of mixed lesions. With strict criteria, that is, none, 15 or one, micropapillation/cribriform space in one or several ducts with flat epithelial atypia (as in the present study), no cancer was found at excision. Micropapillary lesions seem to be an intermediate step between flat epithelial atypia and pure non-micropapillary atypical ductal hyperplasia with 43 and 61% of cancers at surgery.…”

Section: Interobserver Reproducibility In the Classification Of Epithmentioning

confidence: 59%

“…1 This would indicate that excision is more often not warranted, but there are still no clear guidelines for the management of patients when epithelial atypia are diagnosed at microbiopsy. Up until now, most reports published in the literature [2][3][4][5][6][7][8][9][10][11][12][13][14][15] have focused on underestimation of lesions at microbiopsy when compared with surgical excisions. Some authors have identified patients who should or should not be spared surgery when epithelial atypia were diagnosed at microbiopsy performed for microcalcifications, but criteria to excise or not differ according to the authors.…”

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confidence: 99%

“…Some authors have identified patients who should or should not be spared surgery when epithelial atypia were diagnosed at microbiopsy performed for microcalcifications, but criteria to excise or not differ according to the authors. 12,[14][15][16] Jackman et al 7 report that no clinical, mammographic or biopsy features alone or in combination can be used to define a substantial subset of probably benign lesions with a o2% chance of cancer at surgery. In all these studies, the number of microbiopsies performed was far greater than the number of subsequent surgical excisions (from 31 (11) to 116 (12)) and only small numbers of cancer diagnosed (3 (8) to 29 (12)).…”

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confidence: 99%

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All atypia diagnosed at stereotactic vacuum-assisted breast biopsy do not need surgical excision

et al. 2011

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The necessity of excision is debatable when atypia are diagnosed at stereotactic vacuum-assisted breast biopsy (microbiopsy). Among the 287 surgical excisions performed at Institut Bergonié from 1999 to 2009, we selected a case-control study group of 151 excisions; 52 involving all the diagnosed cancers and 99 randomly selected among the 235 excisions without cancer, following atypical microbiopsy (24 flat epithelial atypia; 50 atypical ductal hyperplasia; 14 lobular neoplasia; 63 mixed lesions). Mammographical calcification (type, extension, complete removal) and histological criteria of epithelial atypia (type, number of foci, size/extension), topography and microcalcification extension at microbiopsy were compared according to the presence or absence of cancer at excision. Factors associated with cancer at excision were Breast Imaging Reporting and Data System (BI-RADS5) lesions, large and/or multiple foci of mammographical calcifications, histological type, number, size and extension of atypical foci. Flat epithelial atypia alone was never associated with cancer at excision. BI-RADS5, atypical ductal hyperplasia (alone or predominant) and 43 foci of atypia were identified as independent pejorative factors. There was never any cancer at excision when these pejorative factors were absent (n ¼ 31). Presence of one (n ¼ 59), two (n ¼ 23) or three (n ¼ 14) factors was associated with cancer in 24, 15 and 13 cases with an odds ratio ¼ 5.8 (95% CI: 3-11.2) for each additional factor. We recommend that mammographical data and histological characteristics be taken into account in the decision-making process after diagnosis of atypia on microbiopsy. With experienced senologists and strict histological criteria, some patients could be spared surgery resulting in significant patient, financial and time advantages.

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Section: Criteria In the Literature On Which To Decide Whether Or Notsupporting

confidence: 91%

Section: Interobserver Reproducibility In the Classification Of Radiocontrasting

confidence: 39%

Section: Interobserver Reproducibility In the Classification Of Epithmentioning

confidence: 59%

mentioning

confidence: 99%

mentioning

confidence: 99%

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All atypia diagnosed at stereotactic vacuum-assisted breast biopsy do not need surgical excision

et al. 2011

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Clinicopathologic characteristics of carcinomas that develop after a biopsy containing columnar cell lesions

Boulos

Dupont

Schuyler

et al. 2011

Cancer

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BACKGROUND: Columnar cell lesions are frequently associated with atypical ductal hyperplasia, lobular neoplasia, and tubular carcinoma, and have been suggested as a precursor lesion for low-grade carcinomas. However, in longterm follow-up studies, columnar cell lesions are associated with only a slight increase in later breast cancer development. If columnar cell lesions are precursor lesions, one would expect subsequent cancers to develop at the same site as the biopsy and to be preferentially of low grade. The goal of this article is to review the clinical and pathologic features of carcinomas that develop after a diagnosis of columnar cell lesion to try to establish whether these lesions are precursors to low-grade invasive carcinoma. METHODS: The authors reviewed biopsies containing columnar cell lesions, using the criteria of Schnitt and Vincent-Salomon, from 77 women in the Nashville Breast Cohort who developed subsequent breast carcinoma. Clinicopathologic features including laterality, type, and grade of the subsequent cancer were recorded. RESULTS: Breast cancer developed a median of 11 years after initial biopsy. The median age at diagnosis was 60 years. The majority of invasive carcinomas were of no special type and of intermediate grade. Moreover, the carcinomas were as likely to occur in the contralateral breast as in the breast that was originally diagnosed with columnar cell lesion, regardless of columnar cell lesion subtype (P ¼ .48). CONCLUSIONS: Carcinoma subsequent to columnar cell lesions may occur in either breast and tends to show a similar grade and type distribution as sporadic breast cancer. These findings argue against columnar cell lesions being a true precursor for lowgrade invasive carcinoma.

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Progression risk of columnar cell lesions of the breast diagnosed in core needle biopsies

Verschuur-Maes

Witkamp

Bruin

et al. 2011

Intl Journal of Cancer

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Columnar cell lesions (CCLs) of the breast are recognized as putative precursor lesions of invasive carcinoma, but their management remains controversial. We therefore conducted a retrospective study on 311 CCLs, diagnosed in 4,164 14‐gauge core needle biopsies (CNB): 221 CCLs without atypia (CCL), 69 with atypia (CCL‐A), and 21 atypical ductal hyperplasias originating in CCL (ADH‐CCL). Two groups were identified: “immediate treatment” group undergoing excision within four months after the CNB diagnosis of CCL (N = 52) and the “wait‐and‐see” group followed up to 8 years (median 3.5 years, N = 259). In 7 of 31 women (22.5%, 1 CCL, 4 CCL‐A, 2 ADH‐CCL) who underwent immediate surgical excision and were initially biopsied for microcalcifications, ductal carcinoma in situ (DCIS) was present and in 2/31 women (6.5%, 1 CCL, 1 CCL‐A) invasive carcinoma. In 2/21 excisions (9.5%, 1 CCL, 1 CCL‐A) initially biopsied for a density, DCIS was present and invasive carcinoma in 5/21 excisions (23.8%, 2 CCL, 3 CCL‐A). In the wait‐and‐see group, 9/259 women (3.5%) developed invasive carcinoma, 6 ipsi, and 3 contralaterally. Progression risks of CCL‐A and ADH‐CCL were 18% and 22%,versus 2% for CCL without atypia (p < 0.001). In conclusion, CCL‐A or ADH‐CCL in a CNB were associated with a high risk of DCIS/invasive carcinoma in immediate surgical excision biopsies. The 8‐years progression risks for CCL‐A and ADH‐CCL were around 20%. This illustrates that an atypical CCL in a CNB may signal the presence of concurrent lesions or development of advanced lesions in future and may justify (“mini”) surgical excision.

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Columnar cell lesions associated with breast calcifications on vacuum-assisted core biopsies: clinical, radiographic, and histological correlations

Cited by 60 publications

References 26 publications

All atypia diagnosed at stereotactic vacuum-assisted breast biopsy do not need surgical excision

All atypia diagnosed at stereotactic vacuum-assisted breast biopsy do not need surgical excision

Clinicopathologic characteristics of carcinomas that develop after a biopsy containing columnar cell lesions

Progression risk of columnar cell lesions of the breast diagnosed in core needle biopsies

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