Jara-Lazaro Ana Richelia, Tse Gary Man-Kit, Tan Puay Hoon
Department of Pathology, Singapore General Hospital, Singapore.
Pathology. 2009 Jan;41(1):18-27. doi: 10.1080/00313020802563486.
Columnar cell lesions of the breast refer to the morphological spectrum of alterations of the epithelial lining of variably dilated acini of the terminal duct lobular unit (TDLU), often related to secretions and calcifications. After decades of varied terminologies, the term of 'flat epithelial atypia' by the World Health Organization (WHO) consensus group encompasses the part of the spectrum where columnar cell change or columnar cell hyperplasia acquires low grade cytological atypia, merging with atypical ductal hyperplasia and low grade ductal carcinoma in situ. Its association with low grade invasive carcinoma and lobular neoplasia, whether by proximity to these lesions, or by similar molecular expressions, has prompted greater scrutiny into its clinical significance. Although recent literature attempts to refine the term 'flat epithelial atypia', the applicability of its morphological criteria in routine diagnostic practice remains to be seen, and interobserver variability is highly possible. This poses even greater challenges especially in limited samples of breast tissue, such as in core biopsies, for pre-operative decision-making. The purpose of this review is to elucidate evolving clinical and diagnostically relevant principles that surround and influence the significance of this still controversial entity, especially when discovered on core biopsy in the initial phase of breast diagnosis and management.
乳腺柱状细胞病变是指终末导管小叶单位（TDLU）中不同程度扩张的腺泡上皮内衬形态学改变的范围，常与分泌物和钙化有关。经过数十年各种不同的术语后，世界卫生组织（WHO）共识小组提出的“扁平上皮异型增生”一词涵盖了柱状细胞改变或柱状细胞增生出现低级别细胞学异型性的那部分病变范围，它与非典型导管增生及低级别导管原位癌相连续。其与低级别浸润性癌和小叶肿瘤的关联，无论是通过与这些病变的邻近关系，还是通过相似的分子表达，都促使人们对其临床意义进行更深入的审视。尽管近期文献试图对“扁平上皮异型增生”一词进行细化，但其形态学标准在常规诊断实践中的适用性仍有待观察，而且观察者间的差异很可能存在。这尤其给乳腺组织有限样本（如粗针活检样本）的术前决策带来了更大挑战。本综述的目的是阐明围绕并影响这一仍存在争议的实体的临床及诊断相关的不断演变的原则，尤其是在乳腺诊断和管理的初始阶段在粗针活检中发现该病变时。
