Immunohistochemical Expression of Estrogen Receptor in Enlarged Lobular Units With Columnar Alteration in Benign Breast Biopsies

Abstract

The prognostic and therapeutic implications of estrogen receptor (ER) status in breast cancer are well known. Whether ER status plays a role in benign breast lesions and the progression to malignancy has not been proven. Enlarged lobular units with columnar alteration (ELUCA), also known as unfolded lobular units, have been associated with mild elevations in subsequent breast cancer risk. We examined the association of ERalpha expression in ELUCA with invasive breast cancer risk. A nested case-control study was performed of women with ELUCA who had undergone benign breast surgery. Eighty-two women who developed invasive breast cancer on follow-up were matched by age and year of biopsy with 166 women who did not develop invasive breast cancer. Entry biopsies were stained for ERalpha (clone 6F11) without knowledge of subsequent cancer outcome. ELUCA lesions were scored as positive if greater than 10% of epithelial nuclei stained with ERalpha and at least one ELUCA contained >50% of cells staining for ERalpha. Relative risks of breast cancer were estimated by odds ratios derived from conditional logistic regression analyses. Thirty-nine percent of cases and 56% of controls had positive ERalpha staining in ELUCA. The relative risk of invasive breast cancer in women with ERalpha-negative ELUCA was 1.85 times that of women with ERalpha-positive lesions (95% confidence interval, 1.0-3.4, P=0.04). The presence of ERalpha staining in women with ELUCA is associated with a lower risk of developing subsequent invasive carcinoma. These findings have implications for risk assessment in benign breast biopsies and are of particular interest given the controversy currently surrounding hormone replacement therapy.

Clinicopathologic characteristics of carcinomas that develop after a biopsy containing columnar cell lesions

“…6,9,10 Entry biopsies were performed between 1965 and 1982. The authors reviewed the available histologic slides from 54 women (70%), and for the remaining 23 women, information was obtained from pathology reports (n ¼ 13), subject interviews or medical records (n ¼ 8), and death certificates (n ¼ 2).…”

Management of flat epithelial atypia on breast core biopsy may be individualized based on correlation with imaging studies

“…5 Columnar cell lesions have been referred to as 'blunt duct adenosis', [6][7][8] 'hyperplastic enlarged lobular units', 9 'columnar alteration with prominent apical snouts and secretions', 10 and 'enlarged lobular units with columnar alteration'. 11 Flat epithelial atypia has been referred to as 'clinging carcinoma, monomorphic type', 12 ductal intraepithelial neoplasia, 13 and columnar cell change or columnar cell hyperplasia with atypia. 14 The current WHO classification recognizes three diagnostic categories: columnar cell change, columnar cell hyperplasia, and flat epithelial atypia.…”

Columnar cell lesions associated with breast calcifications on vacuum-assisted core biopsies: clinical, radiographic, and histological correlations

“…[3][4][5][6][7] According to Schnitt and Vincent-Salomon, 1 columnar cell lesions have been grouped into the categories of columnar cell change and columnar cell hyperplasia without or with atypia. Other authors 8 have proposed a subcategorization of columnar cell lesions depending on the presence of architectural and/or cytological atypia.…”