Conservative management of screen-detected radial scars: role of mammotome excision

Abstract

AimsTraditionally, a core biopsy diagnosis of radial scar will prompt diagnostic surgery because of the risk of associated malignancy. However, in the absence of atypia, the risk of malignancy is low. The recent introduction of the mammotome device facilitates vacuum-assisted large-volume sampling of a lesion, such that a benign diagnosis may be accepted more confidently, and if the lesion has been entirely removed, it effectively becomes a therapeutic procedure. The aim of this study was to review the role of mammotome excision in the management of non-atypical radial scars in the screening population.MethodsScreen-detected radial scars diagnosed on core biopsy between July 2004 and September 2008 were identified from pathology records. From January 2006, the mammotome device was used to excise non-atypical radial scars on core biopsy, as an alternative to surgery.Results22 core biopsy samples containing radial scars without atypia were included in the study; 14 were planned for mammotome excision and eight for diagnostic surgical excision. In the mammotome group, 78% (11/14) of patients had confirmation of non-atypical radial scars and thus avoided an operation. Three of the 14 cases planned for mammotome excision required surgery; in one case, the mammotome cores contained lobular in situ neoplasia, and, in two cases, attempts to sample the lesion with the mammotome were unsuccessful. Only one of the 22 cases ultimately proved malignant. This was a case of ductal carcinoma in situ arising within a radial scar, where the patient proceeded straight to surgery in view of discordance between radiological and pathological features.ConclusionUtilisation of mammotome excision in the management of non-atypical radial scars successfully avoided surgery in 78% of eligible patients. Pathologists have an important role in selecting patients for mammotome excision by excluding the presence of atypia.

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

“…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.…”

Paradigm Shifts in Breast Care Delivery: Impact of Imaging in a Multidisciplinary Environment

“…A mass lesion, as opposed to calcifications, with an associated high-risk proliferative breast lesion is more worrisome and may require excision, especially those involving an atypical papillary lesion (38, 39). For lesions including radial scar, papilloma and mucocele-like lesion that have been sampled with a large-gauge vacuum assisted device revealing no atypia at histopathology, the probability of finding a higher grade lesion at excision is markedly reduced; such patients may be followed without the need for surgery (40, 41). Additionally, vacuum assisted biopsy devices have been employed for the percutaneous acquisition of additional large volume tissue samples in lieu of surgery when an initial 14–gauge limited core biopsy sample exhibits these lesions without atypia (40, 41).…”

Practical Considerations in Breast Papillary Lesions: A Review of the Literature

“…[85][86][87][88][89][90] Complete excision of CSLs by mammotome may be followed by serial imaging studies when care is taken regarding pathologic and radiologic correlation. [91][92] Small, incidental CSLs lacking atypia, found on core biopsy, and completely contained within the cores can be followed by serial imaging. [91][92] ENCAPSULATED PAPILLARY CARCINOMA…”