Radial Scars and Complex Sclerosing Lesions of the Breast: Prevalence of Malignancy and Natural History Under Active Surveillance

Kraft, Elizabeth; Limberg, Jessica; Dodelzon, Katerina; Newman, Lisa A.; Simmons, Rache M.; Swistel, Alexander; Ginter, Paula S.; Marti, Jennifer L.

doi:10.1245/s10434-021-09713-5

Cited by 18 publications

(12 citation statements)

References 17 publications

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“…In our study, 30 RS lesions without atypia did not undergo surgical excision; all had stable, benign imaging findings for a median duration of 3 years following biopsy, strongly supporting benignity. Another study demonstrating similar results is Kraft et al, where 50 of 50 patients undergoing active surveillance instead of excision did not progress on follow-up imaging (35). This is a larger cohort than in previous studies followed with imaging alone rather than surgical excision (23,33,34,38).…”

Section: Discussionsupporting

confidence: 71%

“…This study was limited in its ability to recommend management practice given the small sample size. These are inherent limitations when studying an uncommon pathologic state at a small number of centers, though it does examine a larger cohort than some previous studies (33,35,39). In addition, nine patients were lost to follow-up; the upgrade rate could thus potentially be higher than the one reported.…”

Section: Discussionmentioning

confidence: 92%

See 1 more Smart Citation

Malignancy Upgrade Rates of Radial Sclerosing Lesions at Breast Cancer Screening

Yan

DeMello

Baird

et al. 2021

Radiology: Imaging Cancer

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 92%

Malignancy Upgrade Rates of Radial Sclerosing Lesions at Breast Cancer Screening

Yan

DeMello

Baird

et al. 2021

Radiology: Imaging Cancer

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“…This risk has led to the recommendation for surgical excision for lesions with atypia. Alternatives to surgery may include hormonal therapy or close surveillance [25,26]. Certain pathology subtypes such as radial scar without atypia, complex sclerosing lesions, or intraductal papilloma without atypia are less likely to be upstaged to cancer, indicating that surveillance without excision may be an acceptable management option for these lesions [25,26].…”

Section: Discussionmentioning

confidence: 99%

“…Alternatives to surgery may include hormonal therapy or close surveillance [25,26]. Certain pathology subtypes such as radial scar without atypia, complex sclerosing lesions, or intraductal papilloma without atypia are less likely to be upstaged to cancer, indicating that surveillance without excision may be an acceptable management option for these lesions [25,26]. Given the nuances in risk and many treatment options, patients with high-risk benign breast lesions should be counseled by a breast specialist on their individual risk and available prevention methods [27].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Nurse Navigation on Timeliness to Treatment for Benign High-Risk Breast Pathology

Barker

Chung

Mukherjee

et al. 2022

Preprint

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Purpose High-risk breast pathology is a breast cancer risk factor for which timely treatment is crucial. Nurse navigation programs have been implemented to minimize delays in patient care. This study evaluated nurse navigation in terms of timeliness to surgery for patients with high-risk breast pathology. Methods This was a single-institution, retrospective review of patients with identified high-risk breast pathology undergoing lumpectomy between January 2017 and June 2019. Patients were stratified into cohorts based on periods with and without nurse navigation. Preoperative and postoperative time to care as well as demographic and tumor characteristics were compared using univariate and multivariate analysis. Results 100 patients had assigned nurse navigators and 29 patients did not. Nurse navigation was associated with reduced time from referral to date of surgery (DOS) by 16.9 days (p=0.003). Patients >75 years had a shorter time to first appointment (p=0.03), and patients with Medicare insurance had a reduced time from referral to DOS (p=0.005). 20% of all patients were upstaged to cancer on final surgical pathology. Conclusion Nurse navigation was significantly associated with decreased time to care for patients with high-risk breast pathology undergoing lumpectomy. We recommend nurse navigation programs as part of a comprehensive approach for patients with high-risk breast pathology.

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“…4 The American Society of Breast Surgeons (ASBrS) recommends routine surgical excision of RS/CSL with consideration of surveillance for small, adequately sampled lesions. 20 We sought to characterize management of consecutively identi ed patients with RS/CSL on CNB at a single institution between 2015-2020 and evaluate factors associated with the upgrade of RS/CSL among patients who underwent surgical excision.…”

Section: Introductionmentioning

confidence: 99%

A Single Center Report on the Upgrade Rate of Radial Scar/Complex Sclerosing Lesions of the Breast

Smullin

Lawton

et al. 2022

Preprint

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Introduction: Radial scar/complex sclerosing lesion (RS/CSL) is a benign breast lesion. The incidence of RS/CSL on core needle biopsy (CNB) ranges from 0.6 to 3.7%. Despite benign pathology, the radiographic appearance of RS/CSL can be indistinguishable from invasive or in situ malignancy. The upgrade rate of RS/CSL to malignancy varies widely. Whether there are RS/CSL on CNB that may be safely observed without surgery is not well understood. Methods: We performed a single center retrospective study of females over 18 with radiology-pathology concordant diagnosis of RS/CSL on CNB from 2015–2020. We excluded patients with ipsilateral or contralateral invasive or in situ malignancy within 3 months prior to or after biopsy proven RS/CSL. Management was immediate surgical excision within 6 months or imaging surveillance. Upgrade rate was determined in the cohort of patients who underwent surgical excision based on evidence of in situ or invasive malignancy. Results: We identified 83 patients with RS/CSL; 56 (67%) underwent surgical excision and 27 (33%) underwent surveillance. Those who underwent surgical excision had a significant higher rate of breast cancer in the family (41% vs 15%, p = 0.02) and concurrent atypia on CNB (16% vs 0%, p = 0.03). After surgical excision, 11 cases upgraded to atypia and one case upgraded to ductal carcinoma in situ. There were no factors associated with upgrade to malignancy. Conclusion: Upgrade rates of RS/CSL to malignancy remain low; however a significant number upgrade to atypia, which offers relevant information for risk stratification. Further research is needed before omission of excision of RS/CSL can be safely considered.

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Radial Scars and Complex Sclerosing Lesions of the Breast: Prevalence of Malignancy and Natural History Under Active Surveillance

Cited by 18 publications

References 17 publications

Malignancy Upgrade Rates of Radial Sclerosing Lesions at Breast Cancer Screening

Malignancy Upgrade Rates of Radial Sclerosing Lesions at Breast Cancer Screening

The Impact of Nurse Navigation on Timeliness to Treatment for Benign High-Risk Breast Pathology

A Single Center Report on the Upgrade Rate of Radial Scar/Complex Sclerosing Lesions of the Breast

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