Columnar cell lesions with atypia: radiological features and surgical outcome

Background and objective

Columnar cell change with atypia (CCCA) is increasingly diagnosed on core biopsy for indeterminate microcalcification, and may be associated with noninvasive ductal carcinoma in situ (DCIS) or invasive cancer. Few data exist on the risk of cancer in isolated CCCA lesions. We aimed to determine the rate of surgical upgrade to malignancy in CCCA and the predictive imaging features.

Methods

A 5-year retrospective search of our database revealed CCCA as the primary finding in 21 cases of core biopsy. We reviewed mammographic features and surgical histology for each case.

Results

All cases were screen-detected via indeterminate microcalcification on the mammogram; none had a palpable mass. Three patients declined surgery; 14 patients underwent diagnostic surgical excision and four patients had vacuum excision. Overall, 33% (n = 6) were upgraded to cancer; comprising low-grade DCIS (n = 2), invasive ductal carcinoma (n = 2), G1 tubular (n = 1) and G1 apocrine (n = 1). Of those surgically excised (n = 14), 43% were upgraded to cancer. Sixty-six per cent of cases (n = 12) revealed CCCA alone or with other benign changes. A microcalcification cluster size >10 mm appeared predictive for upgrade.

Conclusion

CCCA presents as nonpalpable, clustered indeterminate microcalcifications on mammography. From this series, we recommend surgical excision for all cases where atypia is found with columnar cell change.