Columnar cell lesions without atypia initially diagnosed on breast needle biopsies: is imaging follow-up enough?
OBJECTIVE
The purpose of this study was to evaluate the underestimation rate and predictive factor of underestimation of columnar cell lesions (CCLs) without atypia diagnosed through breast core needle biopsies (CNBs).


METHODS
From January 2007 through December 2011, 141 CCLs without atypia, including columnar cell change and columnar cell hyperplasia, were diagnosed in 138 women by CNB. Excisional (n = 16) or imaging follow-up (n = 125) findings were available in all cases. On a per-lesion basis, the underestimation rate and predictive factor of underestimation were evaluated.


RESULTS
Among the 16 surgically excised lesions, there were two malignancies (one ductal carcinoma in situ and one invasive ductal carcinoma) and one lobular carcinoma in situ. Overall, the pooled underestimation rate of malignancy was 1.4% (2/141). With regard to lesion variables, the mean lesion size was significantly larger in the underestimation group of CCLs (p = 0.007). Fine pleomorphic morphology of microcalcifications (p < 0.001), the distribution of the microcalcifications (p = 0.007), BI-RADS final assessment (p = 0.001), and imaging-pathologic correlation (p < 0.001) were significantly associated with underestimation. Multivariate analysis showed that fine pleomorphic morphology of microcalcifications (p < 0.0001) was an independent predictor of underestimation in 58 lesions with microcalcifications on mammography.


CONCLUSIONS
The overall underestimation rate of malignancy was 1.4%. Imaging follow-up is reasonable for CCLs without atypia at CNB, especially in small lesions with less suspicious imaging findings. Fine pleomorphic microcalcifications and higher BI-RADS category might be helpful in the prediction of underestimation of a high-risk lesion or malignancy.
1 Department of Radiology, Seoul National University Hospital, 28, Yongon-dong, Chongno-gu, Seoul 100-744, Republic of Korea.
Mirinae
M
Seo
Jung Min
JM
Chang
Won Hwa
WH
Kim
In-Ae
IA
Park
Su Hyun
SH
Lee
Nariya
N
Cho
Woo Kyung
WK
Moon
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012680:Sensitivity and Specificity