Do breast columnar cell lesions with atypia need to be excised?

Area of Science:

• Pathology
• Oncology
• Breast Imaging

Background:

• Columnar cell lesion with atypia (CCLA) is a newly identified breast pathology.
• The association between CCLA and breast cancer risk is not well-established.
• CCLA has been observed adjacent to various breast carcinomas.

Purpose of the Study:

• To investigate the incidence of abnormal pathology adjacent to CCLA in breast specimens.
• To determine the significance of CCLA in the context of breast cancer development.

Main Methods:

• Retrospective review of 21 breast specimens with CCLA by a pathologist.
• Classification of specimens by biopsy type: core biopsy, excisional biopsy, and simple mastectomy.
• Analysis of adjacent tissues for in situ and invasive carcinomas and other proliferative lesions.

Main Results:

• Abnormal pathology was found adjacent to CCLA in 13 out of 21 specimens (62%).
• In core biopsies, 6 of 8 (75%) showed adjacent abnormalities, including infiltrating ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS).
• In excisional biopsies, 5 of 11 (45%) had adjacent abnormalities, including IDC and DCIS.

Conclusions:

• A significant proportion of CCLA cases are associated with adjacent abnormal breast pathology.
• Careful examination for atypia in CCLA is crucial.
• Surgical excision is recommended for CCLA identified on core biopsy, pending further research on future breast cancer risk.