title: Columnar cell lesions on breast needle biopsies: is surgical excision necessary? A systematic review.
abstract: OBJECTIVE
  This systematic review was conducted to provide treatment recommendations for patients with a diagnosis of columnar cell lesions (CCLs) in a breast core needle biopsy (CNB).
  
  
  BACKGROUND
  CCLs are putative breast cancer precursors and are often associated with (in situ) carcinoma in excision specimens. Although several studies reported on the progression risk and underestimation rate of a CNB diagnosis of CCL, there is no consensus regarding optimal clinical management in this context.
  
  
  METHODS
  We searched MEDLINE, Embase, and Cochrane databases from 1990 to October 2010 for studies on patients with a CNB diagnosis of CCL without atypia, CCL with atypia and atypical ductal hyperplasia associated with CCL followed by surgical excision or clinical follow up.
  
  
  RESULTS
  Of 1759 selected articles, 24 were included in this review. The pooled underestimation risks for (in situ) carcinoma were as follow: CCL without atypia 1.5% (95% confidence interval [CI] 0.6%-4%), CCL with atypia 9% (95% CI: 5%-14%), and atypical ductal hyperplasia associated with CCL 20% (95% CI: 13%-28%), based on the whole groups of patients with a CNB. Studies including CCLs with long-term clinical follow-up showed a trend toward a limited elevated breast cancer risk.
  
  
  CONCLUSIONS
  On the basis of the (in situ) carcinoma underestimation rates of patients with a CNB diagnosis of CCL with atypia and atypical ductal hyperplasia associated with CCL, surgical excision should be considered. For CCL without atypia, more studies with a long-term follow-up are required, but so far, surgical excision biopsy does not seem to be necessary.
authors: Department of Pathology, University Medical Center Utrecht, The Netherlands.
authors: Anoek H J
authors: AH
authors: Verschuur-Maes
authors: Carolien H M
authors: CH
authors: van Deurzen
authors: Evelyn M
authors: EM
authors: Monninkhof
authors: Paul J
authors: PJ
authors: van Diest
mesh_terms: D001707:Biopsy, Needle; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002278:Carcinoma in Situ / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery*; D012306:Risk