Senetta Rebecca, Campanino Pier Paolo, Mariscotti Giovanna, Garberoglio Sara, Daniele Lorenzo, Pennecchi Francesca, Macrì Luigia, Bosco Martino, Gandini Giovanni, Sapino Anna
Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy.
Mod Pathol. 2009 Jun;22(6):762-9. doi: 10.1038/modpathol.2009.21. Epub 2009 Mar 13.
Columnar cell lesions of the breast are increasingly recognized at mammography for their tendency to calcify. We studied 392 vacuum-assisted core biopsies performed solely for calcifications to evaluate the frequency of columnar cell lesions, their relationship with radiological risk, appearance of calcifications, and clinical data. Management and follow-up of columnar cell lesions without and with atypia (flat epithelial atypia) was analyzed. Cases with architectural atypia (cribriform spaces and/or micropapillae) were excluded from flat epithelial atypia. Calcifications were within the lumen of acini affected by columnar cell lesions in 137 out of 156 biopsies diagnosed with some columnar cell lesions. These represented 37% of vacuum-assisted core biopsies and 62% of low radiological risk (BI-RADS3) calcifications. High-risk (BI-RADS5) calcifications were never associated with columnar cell lesions. Age and menopausal status were comparable in columnar and in not-columnar cell lesions. Atypia was associated with long-term hormone replacement therapy in both lesions. Surgical biopsy was recommended for all cases with atypia. Flat epithelial atypia, as the only histological findings on vacuum-assisted core biopsies, was never associated with malignancy at surgery. In conclusion, we suggest that surgical excision is not mandatory when flat epithelial atypia is found as the most advanced lesion on vacuum-assisted core biopsy performed for low radiological risk calcifications, and that women should be advised of the possible hormone dependency of this entity.
乳腺柱状细胞病变因其钙化倾向在乳腺钼靶检查中越来越多地被发现。我们研究了392例仅因钙化而进行的真空辅助粗针活检，以评估柱状细胞病变的发生率、它们与放射学风险的关系、钙化表现及临床资料。分析了无非典型性和有非典型性（扁平上皮非典型增生）的柱状细胞病变的处理及随访情况。具有结构非典型性（筛状间隙和/或微乳头）的病例被排除在扁平上皮非典型增生之外。在156例诊断为某种柱状细胞病变的活检中，有137例的钙化位于受柱状细胞病变影响的腺泡管腔内。这些钙化占真空辅助粗针活检的37%，以及低放射学风险（BI-RADS3）钙化的62%。高风险（BI-RADS5）钙化从未与柱状细胞病变相关。柱状细胞病变组和非柱状细胞病变组的年龄及绝经状态相当。两种病变中的非典型性均与长期激素替代治疗有关。所有非典型性病例均建议行手术活检。作为真空辅助粗针活检唯一组织学发现的扁平上皮非典型增生，在手术时从未与恶性肿瘤相关。总之，我们建议，对于因低放射学风险钙化而进行的真空辅助粗针活检中发现扁平上皮非典型增生为最严重病变的情况，手术切除并非必要，并且应告知女性该病变可能存在激素依赖性。
