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Columnar Cell Lesions of the Breast: Mammographic Findings with Histopathologic Correlation¹

¹ From the School of Medicine, Virginia Commonwealth University, Richmond, Va (S.P.); Commonwealth Laboratory Consultants, Henrico Doctors’ Hospital-Forest Campus, Richmond, Va (M.J.K.); and Ellen Shaw de Paredes Institute for Women’s Imaging, 4480 Cox Rd, Suite 100, Glen Allen, VA 23060 (W.S., E.S.d.P.). Recipient of a Certificate of Merit award for an education exhibit at the 2006 RSNA Annual Meeting. Received April 2, 2007; revision requested April 24 and received May 28; accepted June 5. Supported in part by a grant from the Ellen Shaw de Paredes Research Foundation. Address correspondence to E.S.d.P. (e-mail: esdp{at}paredesinstitute.com).

Because of advances in mammography and a concomitant rise in the number of breast biopsies being performed for mammographically detected abnormalities, increasing numbers of columnar cell lesions (CCLs) are being described by pathologists. However, these lesions can be challenging to manage, since their classification has changed over time and only limited research has been conducted regarding their clinical significance. CCLs may be characterized by a single layer of columnar cells (columnar cell change [CCC]), multiple layers with stratification and apical tufting (columnar cell hyperplasia [CCH]), or monomorphic cells with cytologic atypia (flat epithelial atypia [FEA]). The differentiation between CCC, CCH, and FEA is clinically significant: CCC and CCH are considered benign lesions, whereas FEA can be associated with, and even a precursor to, low-grade ductal carcinoma in situ and atypical ductal hyperplasia. Therefore, the identification of FEA at core biopsy should prompt excision of the remaining portion of the lesion.

© RSNA, 2007