Radial scars/complex sclerosing lesions of the breast: radiologic and clinicopathologic correlation

Abstract

BackgroundWe investigated the radiologic and clinical findings of radial scar and complex sclerosing lesions, and evaluated the rate of pathologic upgrade and predicting factors.MethodsFrom review of our institution’s database from January 2006 to December 2012, we enrolled 82 radial scars/complex sclerosing lesions in 80 women; 51 by ultrasound guided core needle biopsy, 1 by mammography-guided stereotactic biopsy, and 38 by surgical excision. The initial biopsy pathology revealed that 53 lesions were without high risk lesions and 29 were with high risk lesions. Radiologic, clinical and pathological results were analyzed statistically and upgrade rates were calculated.ResultsOf the 82 lesions, 64 (78.0%) were surgically excised. After surgical excision, two were upgraded to DCIS and two were upgraded to lesions with high risk lesions. The rate of radial scar with high risk lesions was significantly higher in the surgical excision group (11.1% vs. 42.2%, p = 0.015), which also demonstrated larger lesion size (10.7 ± 6.5 vs. 7.1 ± 2.6 mm, p = 0.001). The diagnoses with high risk lesions on final pathological results showed older age (52.9 ± 6.0 years vs. 48.4 ± 6.7 years, p = 0.018).ConclusionsRadial scars with and without high risk lesions showed no statistically significant differences in imaging, and gave relatively low cancer upgrade rates.Electronic supplementary materialThe online version of this article (10.1186/s12880-018-0279-z) contains supplementary material, which is available to authorized users.

Positive Predictive Value of Tomosynthesis-guided Biopsies of Architectural Distortions Seen on Digital Breast Tomosynthesis and without an Ultrasound Correlate

“…The cancer upgrade rates are low. [15,16] The PPV of DBT guided biopsies of AD at our center exceeds the 2% threshold of BI-RADS 3. Since differentiating benign from malignant causes of AD on imaging is difficult, we recommend DBT-guided biopsy of AD as the next step in the management of AD at our institute.…”

“…The upgrade rates vary from <2% to 18%. [15,16,23,24] In our opinion, excluding patients who did not undergo surgery could contribute to statistical bias by preferentially decreasing the denominator and hence, resulting in higher PPV. Hence, for completeness, the PPVs are reported with histopathology results from core-needle biopsy alone and from all available histopathology that include the results from both core- needle biopsy and from surgery (if performed).…”

“…It is difficult to distinguish malignancies associated with AD based on imaging morphology. [2-4,7-9,14-16] The workup of AD includes full-field, spot compression or magnification, two-dimensional digital mammography (DM), full-field or spot-compression DBT, targeted ultrasound (US), problem- solving magnetic resonance imaging (MRI), and/or imaging- guided biopsy. [3,7] Although DBT-guided percutaneous biopsies and needle localizations are increasingly utilized, this capability is not yet widely available.…”

High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

“…The MRI appearance of RS/CSL is similarly variable. In Ha et al’s study involving 13 radial scars that were imaged with MRI, six lesions were not detected, six appeared as a mass (three with irregular margins, four with a homogenous enhancement pattern, and five with a Type 3 enhancement kinetic curve), and one appeared as non-mass enhancement with regional, homogeneous enhancement, and a Type 3 enhancement kinetic curve [ 96 ] (Table 3 ).…”

Radial Scar: a management dilemma

“…No consistent correlation has been demonstrated between malignancy at excision of RS and parity, menopausal status and clinical presentation. The only variable with a statistically significant relation to upgrading was the average age (> 50 years), associated with a slightly higher risk [ 50 ].…”