Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases

Matrai, Cathleen; D’Alfonso, Timothy M.; Drotman, Michele; Simmons, Rache M.; Shin, Sandra J.

doi:10.5858/arpa.2014-0550-oa

Cited by 34 publications

(18 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…25 On literature review, a 7% average High-risk breast lesion upgrades upgrade rate was reported with a range of 0-16% when radial scar was diagnosed on core needle biopsy (Table 8). 2,3,15,16,19,23,24,44,[106][107][108][109][110][111][112][113][114][115][116][117][118] Our institutional upgrade rate of 16% was higher than the reported average, likely due to our small case volume (n = 25). No statistically significant radiologic differences were seen between upgraded and not upgraded radial scar core needle biopsy groups in our study.…”

Section: Discussioncontrasting

confidence: 56%

“…Previous research has shown that incidental and small radial scar lesions (o 5 mm) were less likely to be upgraded on excision. 16,110,115 There is no consensus for the management of radial scar without atypia. It may be prudent to recommend conservative excision for radial scar without atypia with radial scar size greater 45 mm.…”

Section: Discussionmentioning

confidence: 99%

“…Upgrade rates to ductal carcinoma in situ or invasive carcinoma from core needle biopsy to excision in the literature range from 0 to 62% for atypical ductal hyperplasia, 0 to 21% for flat epithelial atypia, 0 to 67% for atypical lobular hyperplasia, 0 to 60% for lobular carcinoma in situ, and 0 to 16% for radial scar. [12][13][14][15][16][17][18][19][20][21] Given these data, it is not surprising that the management of high-risk breast lesions seen on core needle biopsy is controversial. More defined upgrade rate data are needed and may prevent over-and undertreatment.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review

2016

View full text Add to dashboard Cite

Optimal management of high-risk breast lesions detected by mammogram yielding atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar without atypia on core needle biopsy is controversial. This is a single-institution retrospective review of 5750 core needle biopsy cases seen over 14.5 years, including 249 (4.3%), 72 (1.3%), 50 (0.9%), 37 (0.6%), and 54 (0.9%) cases of atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar without atypia, respectively. Patient age, radiologic characteristics, needle gauge, and excision diagnoses were recorded. Of 462 high-risk cases analyzed, 333 (72%) underwent excision. Upgrade rate to ductal carcinoma in situ, pleomorphic carcinoma in situ, or invasive mammary carcinoma was 18% for atypical ductal hyperplasia, 11% for flat epithelial atypia, 9% for atypical lobular hyperplasia, 28% for lobular carcinoma in situ, and 16% for radial scar. Carcinoma diagnosed on excision was more likely to be in situ than invasive, and if invasive, more likely to be low grade than high grade. Overall, cases that were benign (vs high risk or carcinoma) on excision were less likely to have residual calcifications after biopsy (17% vs 27%, P=0.013), and more likely to have a smaller mass size (<1 cm) (82% vs 50%, P=0.001). On subgroup analysis, atypical ductal hyperplasia cases that were benign (vs high risk or carcinoma) on excision were more likely to have smaller mass size (<1 cm) (P=0.025). Lobular neoplasia diagnosed incidentally (vs targeted) on core needle biopsy was less likely to upgrade on excision (5% vs 39%, P=0.002). A comprehensive literature review was performed, identifying 116 studies reporting high-risk lesion upgrade rates, and our upgrade rates were similar to those of more recent larger studies. Careful radiological-pathological correlation is needed to identify high-risk lesion subgroups that may not need excision.

show abstract

Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review

2016

View full text Add to dashboard Cite

show abstract

“…In our study, we were able to safely observe the majority of patients with CSL/RSL, and report a low risk of future breast cancer development at a median follow‐up of 2.2 years. This is consistent with the recent report by Matrai et al of 77 radial scar lesions under 0.5 cm diagnosed by core biopsy, of which 47% were deemed concordant and the observed upgrade rate to DCIS or invasive carcinoma was 0%. In addition, all subsequent ipsilateral cancers appeared unrelated to the prior CSL/RSL, found at locations 3 cm or more from the initial CSL/RSL core biopsy site.…”

Section: Discussionsupporting

confidence: 93%

“…Historical literature suggests that these lesions are associated with considerable risk of finding breast carcinoma in adjacent tissue, prompting recommendation for excision . The reported incidence of malignancy on excisional specimens following a diagnosis of CSL/RSL on core needle biopsy varies widely, between 0% and 23% …”

Section: Introductionmentioning

confidence: 99%

Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: Low risk of carcinoma on excision in cases with clinical and imaging concordance

et al. 2017

View full text Add to dashboard Cite

Complex or radial sclerosing lesions (CSL/RSL) are uncommon diagnoses on core needle biopsy with a reported upgrade rate ranging between 0% and 23%. As a result, their management remains controversial. In this study, we sought to determine the rate of malignancy on excision for patients with pure CSL/RSL on core biopsy, and to evaluate future breast cancer risk when CSL/RSL is managed without excision. We retrospectively reviewed 118 cases of CSL/RSL diagnosed on image-guided breast biopsies between 2005 and 2014 at our institution. Of 98 analyzed patients, 34 (35%) underwent excision and 64 (65%) were observed. Demographic and clinical variables between excision and observation groups were compared. In excised specimens, factors associated with upgrade to malignancy were evaluated. The median age at diagnosis was 49 years (range, 27-88 years). In the excision group, 3/34 cases were associated with malignancy, an overall upgrade rate of 9%. All malignant cases had core needle biopsies interpreted as discordant and were BIRADS 4B or more on imaging. In the observation group, at a median follow-up of 2.2 years, 3/64 (5%) patients developed ipsilateral cancers, all of which were distant from the index CSL/RSL. In our series, we report a 9% malignancy rate on excision of BIRADS >4C lesions characterized as CSL/RSL on core biopsy. In patients with concordant biopsies and BIRADS 4A or lower lesions who underwent observation, we found a low rate of subsequent ipsilateral cancers. Further studies are needed to confirm that for CSL/RSL in concordant core biopsies and BIRADS 4A or lower, nonpalpable lesions, observation may be a reasonable alternative to excision.

show abstract

Adenosis, Sclerosing Lesions, Microglandular Adenosis, and Mucocele-Like Lesions

Harrison

2022

A Comprehensive Guide to Core Needle Biopsies of the Breast

View full text Add to dashboard Cite

Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases

Cited by 34 publications

References 18 publications

Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review

Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review

Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: Low risk of carcinoma on excision in cases with clinical and imaging concordance

Adenosis, Sclerosing Lesions, Microglandular Adenosis, and Mucocele-Like Lesions

Contact Info

Product

Resources

About