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

Anoek H J Verschuur-Maes, Arjen J. Witkamp, Peter C. De Bruin, Elsken Van Der Wall, Paul J. Van Diest

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2674-2680
Number of pages7
JournalInternational Journal of Cancer
Volume129
Issue number11
DOIs
Publication statusPublished - Dec 1 2011
Externally publishedYes

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Keywords

  • breast
  • columnar cell lesions
  • core needle biopsy
  • flat epithelial atypia
  • follow-up
  • progression risk

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Verschuur-Maes, A. H. J., Witkamp, A. J., De Bruin, P. C., Van Der Wall, E., & Van Diest, P. J. (2011). Progression risk of columnar cell lesions of the breast diagnosed in core needle biopsies. International Journal of Cancer, 129(11), 2674-2680. https://doi.org/10.1002/ijc.25926