Columnar cell change in the breast is a common finding that can be identified during breast biopsies. It describes a situation where the typical cuboidal cells lining the small ducts and lobules of the breast are replaced by taller, column-shaped cells. This condition is generally considered non-cancerous. It is often discovered incidentally, found when breast tissue is examined for other reasons.
Understanding Columnar Cell Change
Normal breast ducts and glands are lined by a single layer of cuboidal epithelial cells, which appear roughly square-shaped under a microscope. In columnar cell change, these usual cuboidal cells are replaced by cells that are taller than they are wide, resembling columns. These altered columnar cells line the small ducts or lobules, often in one or two layers. They often feature “apical snouts,” small, nipple-like protrusions on the cell surface, and may produce calcium-rich fluid that can lead to calcifications.
Columnar cell change exists along a spectrum, including “columnar cell change without atypia” and “columnar cell change with atypia,” also known as flat epithelial atypia (FEA). Columnar cell change without atypia involves these altered columnar cells without abnormal cellular features. In contrast, columnar cell change with atypia, or FEA, exhibits low-grade cellular abnormalities, meaning the cells show some irregular characteristics, but not enough to be classified as more serious lesions like atypical ductal hyperplasia or ductal carcinoma in situ. The presence of atypia is a significant distinction, altering the finding’s implications.
Columnar cell hyperplasia (CCH) is a related condition with more than two layers of columnar cells, indicating an increased cell count. Both columnar cell change and columnar cell hyperplasia can occur with or without atypia. It is often discovered during a biopsy, such as when investigating microcalcifications seen on a mammogram.
Diagnosis and Detection
Columnar cell change cannot be felt during a self-exam or clinical breast exam. It is not directly visible as a mass on standard imaging tests like mammograms or ultrasounds. Instead, it is often associated with microcalcifications, tiny calcium deposits detectable on mammograms. These calcifications can appear as punctate, round, or coarse clusters.
Diagnosis of columnar cell change is made through a biopsy. This involves removing a small tissue sample from the breast for examination under a microscope by a pathologist. Common biopsy methods include core needle biopsy, often performed when microcalcifications are observed on mammography, or excisional biopsy.
A pathologist plays a central role in diagnosis by examining the tissue. Under the microscope, they identify characteristic columnar-shaped cells, often with apical snouts and associated calcifications. The pathologist also determines if atypia is present by assessing cellular architecture and identifying abnormal features. This microscopic examination distinguishes columnar cell change from other breast lesions with similar appearances.
Implications and Management
The implications of a columnar cell change diagnosis depend on whether atypia is present. When columnar cell change occurs without atypia, it is generally considered a benign finding and does not significantly increase breast cancer risk. Some studies suggest a slight increase in relative risk (approximately 1.5 times) for subsequent breast cancer, often in the context of other proliferative lesions. For these cases, no specific treatment is needed beyond routine breast cancer screening. Regular mammograms and clinical examinations are recommended as part of ongoing surveillance.
In contrast, columnar cell change with atypia (FEA) is considered a “high-risk lesion” or a “lesion of uncertain malignant potential.” It is associated with a slightly increased risk of developing breast cancer. FEA is often found alongside other more significant lesions, such as atypical ductal hyperplasia (ADH), ductal carcinoma in situ (DCIS), or invasive carcinoma (around 5-15% of cases).
Management for columnar cell change with atypia often involves further intervention. Surgical excision is often recommended to rule out co-existing cancer or higher-risk lesions not fully captured in the initial biopsy. This is due to potential underestimation of more serious conditions in the initial biopsy.
Following surgical removal, prognosis is generally excellent. Patients with FEA may also be advised to undergo increased surveillance, including regular mammograms and clinical examinations, to monitor for future changes. It is important to discuss these findings with a healthcare provider to understand personalized risk and appropriate follow-up plans.