Columnar cell lesions of the breast: mammographic and US features

Columnar cell lesions are being encountered with increasing frequency in breast biopsies performed. The purpose of our study was to determine whether columnar cell lesions of the breast have any distinctive imaging characteristics.

We retrospectively reviewed our institutional database for all records of breast pathology obtained in a 17-month period. Columnar cell lesion was diagnosed in 53 lesions and 12 of these 53 lesions contained columnar cell lesions as the sole histopathologic findings. These 12 lesions in nine patients made up our study population. They included columnar cell change (n=4), columnar cell hyperplasia (n=5), and columnar cell hyperplasia with atypia (n=3).

All nine patients underwent mammography and sonography within 1 month of each other. Of the mammograms in nine patients, nine lesions (75%) appeared as clustered amorphous or indistinct (n=5), fine pleomorphic (n=3), or round (n=1) microcalcifications. The tenth lesion showed a focal mass without microcalcifications and the remaining two lesions showed no abnormal findings. At sonography, not-circumscribed masses were depicted in six lesions and microcalcifications were visible in four lesions, of which three lesions were concurrent with masses. There were no sonographically focal lesions in the remaining five. Overall 11 lesions were classified as BI-RADS category 4 (92%) and one as category 3. Of the three lesions with atypia, two were classified as category 4a and one was classified as category 4c, and they showed no distinct imaging appearance from those without atypia.

Columnar cell lesions usually present as nonpalpable, clustered indeterminate or suspicious microcalcifications on mammography. They are indistinguishable from other causes of suspicious microcalcifications such as atypical ductal hyperplasia or ductal carcinoma in situ and require needle biopsy or excisional biopsy for diagnosis.