Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
Department of Pathology and Laboratory Medicine, Emory University Hospital, Emory University School of Medicine, Atlanta, GA 30322, USA.
Curr Oncol. 2022 Aug 11;29(8):5664-5681. doi: 10.3390/curroncol29080447.
Columnar cell lesions (CCLs) of the breast comprise a spectrum of morphologic alterations of the terminal duct lobular unit involving variably dilated and enlarged acini lined by columnar epithelial cells. The World Health Organization currently classifies CCLs without atypia as columnar cell change (CCC) and columnar cell hyperplasia (CCH), whereas flat epithelial atypia (FEA) is a unifying term encompassing both CCC and CCH with cytologic atypia. CCLs have been increasingly recognized in stereotactic core needle biopsies (CNBs) performed for the assessment of calcifications. CCLs are believed to represent the earliest non-obligate precursor of low-grade invasive breast carcinomas as they share molecular alterations and often coexist with entities in the low-grade breast neoplasia pathway. Despite this association, however, the risk of progression of CCLs to invasive breast carcinoma appears low and may not exceed that of concurrent proliferative lesions. As the reported upgrade rates of pure CCL/FEA when identified as the most advanced high-risk lesion on CNB vary widely, the management of FEA diagnosed on CNB remains controversial. This review will include a historical overview of CCLs and will examine histologic diagnostic criteria, molecular alterations, prognosis and issues related to upgrade rates and clinical management.
乳腺柱状细胞病变（CCL）是一种累及终末导管小叶单位的形态学改变，包括各种程度的扩张和增大的腺泡，由柱状上皮细胞排列而成。目前，世界卫生组织将无异型的 CCL 分为柱状细胞改变（CCC）和柱状细胞增生（CCH），而扁平上皮异型性（FEA）是一个统一的术语，包括伴有细胞学异型性的 CCC 和 CCH。CCL 在用于评估钙化的立体定向核心针活检（CNB）中越来越被认识。CCL 被认为是低级别浸润性乳腺癌的最早非必需前体，因为它们具有分子改变，并且经常与低级别乳腺肿瘤途径中的实体共存。然而，尽管存在这种关联，但 CCL 进展为浸润性乳腺癌的风险似乎较低，并且可能不会超过同时存在的增生性病变的风险。由于在 CNB 上被确定为最高危病变时，纯 CCL/FEA 的报告升级率差异很大，因此在 CNB 上诊断出的 FEA 的管理仍然存在争议。这篇综述将包括 CCL 的历史概述，并将检查组织学诊断标准、分子改变、预后以及与升级率和临床管理相关的问题。
