Is radial scar on core needle biopsy a risk factor for malignancy? A single‐center retrospective review and implications for management

Woodward, Steven G.; Nimtz, Karl; HooKim, Kim; Sevrukov, Alexander; Tsangaris, Theodore N.; Willis, Alliric I.; Berger, Adam C.; Lazar, Melissa

doi:10.1111/tbj.13975

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…In Woodward et al, 7 a retrospective review using a single institutional pathology and radiology database was conducted for all radial scars identified on core biopsy from January 2010 to January 2017. The mean age of the patients with benign biopsies was 52.9 years old.…”

Section: Resultsmentioning

confidence: 99%

“…The overall underestimation rate was 38% and the invasive lesion underestimation rate was 2.2%. 7 Gašljević et al, 8 in a retrospective study using a database from the Slovenian National Breast Cancer Screening Program, checked all patients with a radial scar or a complex sclerosing lesion who underwent core needle biopsy between 2008 and 2018. The mean age was 61.5 years old.…”

Section: Resultsmentioning

confidence: 99%

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Underestimation Rate in the Percutaneous Diagnosis of Radial Scar/Complex Sclerosing Lesion of the Breast: Systematic Review

Zanon

Maesaka

Chequin

et al. 2022

Rev Bras Ginecol Obstet

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Objective To evaluate the underestimation rate in breast surgical biopsy after the diagnosis of radial scar/complex sclerosing lesion through percutaneous biopsy. Data Sources A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The PubMed, SciELO, Cochrane, and Embase databases were consulted, with searches conducted through November 2020, using specific keywords (radial scar OR complex sclerosing lesion, breast cancer, anatomopathological percutaneous biopsy AND/OR surgical biopsy). Data collection Study selection was conducted by two researchers experienced in preparing systematic reviews. The eight selected articles were fully read, and a comparative analysis was performed. Study selection A total of 584 studies was extracted, 8 of which were selected. One of them included women who had undergone a percutaneous biopsy with a histological diagnosis of radial scar/complex sclerosing lesion and subsequently underwent surgical excision; the results were used to assess the underestimation rate of atypical and malignant lesions. Data synthesis The overall underestimation rate in the 8 studies ranged from 1.3 to 40% and the invasive lesion underestimation rate varied from 0 to 10.5%. Conclusion The histopathological diagnosis of a radial scar/complex sclerosing lesion on the breast is not definitive, and it may underestimate atypical and malignant lesions, which require a different treatment, making surgical excision an important step in diagnostic evaluation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Underestimation Rate in the Percutaneous Diagnosis of Radial Scar/Complex Sclerosing Lesion of the Breast: Systematic Review

Zanon

Maesaka

Chequin

et al. 2022

Rev Bras Ginecol Obstet

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“…As the histology of these lesions is similar to breast carcinoma, some studies have identified RS as an independent risk factor for developing breast cancer. 5,6 However, other studies do not support a strong relationship, leading to uncertainty with management of these lesions. 7 It has been shown that stereotactic CNB can underestimate presence of in situ or invasive disease on final excisional biopsy.…”

Section: Discussionmentioning

confidence: 99%

Upstage Rate of Complex Sclerosing Lesions/Radial Scars

Jones

Pearce

Khalil

et al. 2022

The American Surgeon™

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Background Radial scars (RS) and complex sclerosing lesions (CSL) are breast radiologic findings described as small, stellate lesions causing architectural distortion. This can mimic malignancy. Core needle biopsy (CNB) is often performed. Advances in breast imaging have led to increased detection of RS/CSL. The upstage rate of RS/CSL to in situ or invasive disease is 0-40%. We sought to determine the upstaging rate of RS/CSL to in situ, invasive disease, or high-risk lesion at our institution to create excision guidelines. Methods The pathology database of a single center was searched for RS/CSL, from January 2013 to September 2020. We included CNB without malignancy or high-risk lesion (eg, atypical ductal hyperplasia). Patient demographics, indications for biopsy, imaging findings, biopsy procedure, and final pathology were collected. Results Forty-four patients were included. 52.3% had CNB for architectural distortion on mammography, 18.2% for mass, 11.4% for calcifications, 2.3% for abnormal MRI, and 15.9% for multiple reasons (eg, calcifications and mass). Most had an ultrasound: 43.2% had no abnormality and 34.1% had a mass. All CNB were vacuum assisted, 65.9% with 9-gauge needle, and averaged 10.0 cores. 77.3% were stereotactic biopsies, 13.6% ultrasound, and 6.8% MRI. 59.1% had excision after CNB. 82.1% of patients did not upstage. One patient upstaged to invasive ductal carcinoma (3.6%) and two patients to high-risk lesion (7.1%). Discussion There was low upstage rate of RS/CSL on excisional biopsy. Centers could consider close surveillance for RS/CSL on CNB. Longer follow-up in cases of deferred excision is needed to ensure oncologic safety.

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