Radial scars diagnosed on breast core biopsy: Frequency of atypia and carcinoma on excision and implications for management

Donaldson, Alana R.; Sieck, Leah; Booth, Christine N.; Calhoun, Benjamin C.

doi:10.1016/j.breast.2016.06.007

Cited by 29 publications

(19 citation statements)

References 41 publications

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“…15 Considerable variation in the upgrading of flat epithelial atypia, atypical ductal hyperplasia, LCIS/atypical lobular hyperplasia and radial scar to malignancy has been reported (flat epithelial atypia: 0-15%, atypical ductal hyperplasia: 22%-32%, LCIS/atypical lobular hyperplasia: 2%-29%, radial scar: 0%-23%), resulting in mixed recommendations that range from radiologic surveillance to diagnostic surgical excision of every high-risk lesion. [16][17][18][19][20][21][22][23][24][25][26] In our series, 29% of excised high-risk lesions proved to be malignant; 20.7% DCIS and 8.3% invasive breast cancer, respectively. Other studies report a somewhat lower likelihood of upgrading to malignancy of 20%-22%.…”

Section: Discussionmentioning

confidence: 46%

“…Several studies advocate radiologic imaging follow‐up for nonatypical papillomas as the malignancy rate of these lesions may be less than 2.5%, whereas others have found that up to 33% of these lesions may prove malignant and therefore recommend complete surgical excision . Considerable variation in the upgrading of flat epithelial atypia, atypical ductal hyperplasia, LCIS/atypical lobular hyperplasia and radial scar to malignancy has been reported (flat epithelial atypia: 0–15%, atypical ductal hyperplasia: 22%–32%, LCIS/atypical lobular hyperplasia: 2%–29%, radial scar: 0%–23%), resulting in mixed recommendations that range from radiologic surveillance to diagnostic surgical excision of every high‐risk lesion . In our series, 29% of excised high‐risk lesions proved to be malignant; 20.7% DCIS and 8.3% invasive breast cancer, respectively.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

Luiten

Korte

Voogd

et al. 2019

Intl Journal of Cancer

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Between January 1, 2011, and December 31, 2016, we studied the incidence, management and outcome of high‐risk breast lesions in a consecutive series of 376,519 screens of women who received biennial screening mammography. During the 6‐year period covered by the study, the proportion of women who underwent core needle biopsy (CNB) after recall remained fairly stable, ranging from 39.2% to 48.1% (mean: 44.2%, 5,212/11,783), whereas the proportion of high‐risk lesions at CNB (i.e., flat epithelial atypia, atypical ductal hyperplasia, lobular carcinoma in situ and papillary lesions) gradually increased from 3.2% (25/775) in 2011 to 9.5% (86/901) in 2016 (p < 0.001). The mean proportion of high‐risk lesions at CNB that were subsequently treated with diagnostic surgical excision was 51.4% (169/329) and varied between 41.0% and 64.3% through the years, but the excision rate for high‐risk lesions per 1,000 screens and per 100 recalls increased from 0.25 (2011) to 0.70 (2016; p < 0.001) and from 0.81 (2011) to 2.50 (2016; p < 0.001), respectively. The proportion of all diagnostic surgical excisions showing in situ or invasive breast cancer was 29.0% (49/169) and varied from 22.2% (8/36) in 2014 to 38.5% (5/13) in 2011. In conclusion, the proportion of high‐risk lesions at CNB tripled in a 6‐year period, with a concomitant increased excision rate for these lesions. As the proportion of surgical excisions showing in situ or invasive breast cancer did not increase, a rising number of screened women underwent invasive surgical excision with benign outcome.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

Luiten

Korte

Voogd

et al. 2019

Intl Journal of Cancer

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“…The surgical upgrade to malignant findings ranges from 0% to 10% [22], however some authors of recent series have suggested that surgical excision may not be necessary for all RS found on CNB and radiologic followup without excision may be appropriate. In a series by Donaldson et al [23] no upgrades were identified in 37 pathologic radiologic concordant RS without atypia that were surgically excised. In another series by Miller et al [24] of 102 benign radial scars on core biopsy, 1% of cases were upgraded to carcinoma.…”

Section: Radial Scarmentioning

confidence: 99%

Pathologic High-risk Lesions, Diagnosis and Management

Murray

2016

Clinical Obstetrics &Amp; Gynecology

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Percutaneous imaging-guided core needle biopsy (CNB) is a less invasive and less expensive alternative to surgical biopsy for the evaluation of breast lesions. After a CNB the radiologist determine if there is concordance between the pathology, imaging and clinical findings. Patient management after CNB diagnosis of high risk breast lesion varies. Surgical excision is warranted for lesions yielding a CNB diagnosis of ADH; however controversy exists regarding the need for surgical excision after CNB diagnosis of radial scar, papillary lesion, ALH, or LCIS. Repeat CNB or surgical excision is warranted if histologic findings and imaging findings are discordant.

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“…However, recent studies with carefully performed correlations between radiological and pathology findings suggest that upgrade to carcinoma on core biopsy occurs in less than 2.0% [ 12 – 15 ]. Furthermore, most of the lesions upgraded from radial scar are ductal carcinoma in situ (DCIS) or low grade ductal or tubular type [ 12 , 13 , 15 ]. The short-term follow-up of radial scars that were not excised has shown no upgrades [ 13 , 15 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

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

Hee

Shin

et al. 2018

BMC Med Imaging

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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.

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Radial scars diagnosed on breast core biopsy: Frequency of atypia and carcinoma on excision and implications for management

Cited by 29 publications

References 41 publications

Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

Pathologic High-risk Lesions, Diagnosis and Management

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

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