Radial scar of the breast: Is it possible to avoid surgery?

Ferreira, Adelmo; Borges, S.; Sousa, A.; Ribeiro, Cátia; Mesquita, Ana Terezinha Marques; Martins, Pedro; Peyroteo, Mariana; Coimbra, Nuno; Leal, Conceição; Reis, Paulo

doi:10.1016/j.ejso.2017.01.238

Cited by 31 publications

(22 citation statements)

References 39 publications

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“…Several authors have reported a significant risk of missed associated carcinoma when RS/CSL is diagnosed on percutaneous biopsy . Others have suggested that percutaneous biopsies are reliable for excluding malignancy, especially when VALCBs are performed . This is mainly due to reports of heterogeneous series.…”

Section: Discussionmentioning

confidence: 99%

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Management of radial scars/complex sclerosing lesions of the breast diagnosed on vacuum‐assisted large‐core biopsy: is surgery always necessary?

et al. 2019

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Aims The diagnosis of radial scars/complex sclerosing lesions (RSs/CSLs) onpercutaneous biopsy carries a risk of histological underestimation. Consequently, surgical excision is often performed in order to exclude a possible associated malignancy. The aim of this study was to assess the rate of ‘upgrade to carcinoma’ upon subsequent surgical excision of RS/CSL cases diagnosed on vacuum‐assisted large‐core biopsy (VALCB). We also analysed the risk factors for upgrade in order to determine a subset of patients who could avoid surgery and benefit from conservative management with clinical and imaging follow‐up. Methods and results This was a retrospective observational single‐centre study on 174 consecutive RS/CSL cases diagnosed on VALCB from May 2008 to October 2015. Univariate analysis was performed to identify clinical, radiological and histological risk factors for upgrade. Surgical excision was performed following VALCB diagnosis of 88 RS/CSL cases with or without associated atypia. The overall rate of surgical upgrade to carcinoma was 9.1% (8/88). None of the benign biopsies without atypia was surgically upgraded. Additional to atypia, risk factors for upgrade were non‐incidental finding of the RS/CSL, the mammographic appearance, and the number of fragments obtained during the biopsy procedure (P < 0.05). Conclusion We demonstrate that VALCB revealing an RS/CSL is reliable for excluding malignancy when there is no associated atypia and when radiological and histological findings are concordant. In such cases, surgery can be avoided in favour of clinical and imaging follow‐up. When an RS/CSL is associated with atypia, the decision to perform surgical excision depends on other associated risk factors.

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Section: Discussionmentioning

confidence: 99%

“…However, there are no published data based on homogeneous cohorts exclusively composed of RS/CSL cases diagnosed on VALCB. Moreover, knowledge on the predictive factors for surgical upgrade is lacking …”

Section: Introductionmentioning

confidence: 99%

Management of radial scars/complex sclerosing lesions of the breast diagnosed on vacuum‐assisted large‐core biopsy: is surgery always necessary?

et al. 2019

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“…Upgrade rates of RS to atypia or malignancy, however, range widely (0%‐40%) 7,8 . There has also been suggestion that the type of CNB impacts upgrade rates but the general conclusion reached from this research advises observation of patients with RS and no other atypia 4,9‐12 . These discrepancies suggest more research is necessary to fully elucidate the optimal treatment when RS are identified on CNB 5 …”

Section: Introductionmentioning

confidence: 83%

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

et al. 2020

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Introduction Reported upgrade rate to malignancy of radial scars (RS) ranges widely (0%‐40%) making management controversial. Methods A retrospective chart review was performed on patients with RS on core needle biopsy (CNB). Upgrade rates to malignancy and atypia on surgical excision were evaluated. Results Of 127 patients with RS on CNB, 53 were excluded due to malignancy or missing records. Of 74 patients reviewed, 52 (70.3%) had surgical excision with four (7.7%) upgraded to malignancy. Eight patients (10.8%) had atypia with RS on CNB with two (25%) upgraded to malignancy. When isolated RS was on CNB, 2 of 44 (4.5%) upgraded to malignancy while 15 of 44 (34%) had atypia on excision. Of 22 patients (29.7%) who did not have excision, zero developed cancer. Conclusion We found higher than expected upgrade rates of isolated RS to atypia which can alter management. Additionally, 25% of RS with atypia upgraded to malignancy suggesting these patients are at higher risk.

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“…Of the 15 other studies, four studies: Nassar et al [ 18 ], Mooney et al [ 3 ], Rageth et al [ 2 ], and Ferreira et al [ 19 ] yielded comparatively high upgrade rates (10.5, 16.0, 10.9, 13.5%, respectively, average upgrade rate 12.6%, 25 of 198 total patients) to malignancy compared to the other 11 studies (average upgrade 1.4%, 12 of 887 patients). The exclusion criteria for first three studies were similar in that patients with any atypia observed with RS on CNB were excluded.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Mooney et al excluded RS associated with any type of epithelial atypia and cases with known synchronous ipsilateral breast cancer [ 3 ]. Ferreria et al excluded patients with a simultaneous breast malignancy (invasive or in situ breast cancer) and also patients with a follow-up interval less than 12 months if surgery was not performed after an image-guided CNB [ 19 ]. Rageth et al did not specifically list exclusion criteria in their publication [ 2 ].…”

Section: Literature Reviewmentioning

confidence: 99%

Radial scar on image-guided breast biopsy: is surgical excision necessary?

Chou

Veis

Aft

2018

Breast Cancer Res Treat

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PurposeRadial scar’s stellate appearance may mimic carcinoma mammographically and histologically. Management of radial scar (RS) found on breast core needle biopsies (CNB) ranges from excision to clinical observation due to the variation in reported upgrades to malignancy at surgical excision. We examined the upgrade rate in patients with RS detected on CNB at our institution and reviewed the current literature.MethodsA retrospective study was conducted of all cases with RS diagnosed on CNB between December 2006 and March 2017 at our institution. Inclusion criteria were patients with “pure” RS and RS associated with high-risk lesions (HRL). Upgrade was defined as invasive or non-invasive cancer in the excisional biopsy.Results157 cases were identified with RS on CNB, and 122 cases met inclusion criteria. Of these 122 cases, 91 (75%) had pure RS on CNB while 31 (25%) had associated atypia or HRL. 81 (66%) of patients proceeded to excisional biopsy and 41 (34%) did not. Two patients (1.6% of total) were found to have a low-grade invasive ductal carcinoma (0.6 and 0.8 cm) upon surgical excision. None of the remaining 120 patients developed an ipsilateral breast cancer with a mean of 32.3-month follow-up.ConclusionsWe found a very low upgrade rate to breast cancer when RS was found on CNB with or without associated HRL. Our results are consistent with other reported series. Our data do not support surgical excision for RS but rather close clinical follow-up for patients with RS on CNB.Electronic supplementary materialThe online version of this article (10.1007/s10549-018-4741-y) contains supplementary material, which is available to authorized users.

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Radial scar of the breast: Is it possible to avoid surgery?

Cited by 31 publications

References 39 publications

Management of radial scars/complex sclerosing lesions of the breast diagnosed on vacuum‐assisted large‐core biopsy: is surgery always necessary?

Management of radial scars/complex sclerosing lesions of the breast diagnosed on vacuum‐assisted large‐core biopsy: is surgery always necessary?

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

Radial scar on image-guided breast biopsy: is surgical excision necessary?

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