Risk of Malignancy When Microscopic Radial Scars and Microscopic Papillomas Are Found at Percutaneous Biopsy

Lee, Karen A.; Zuley, Margarita L.; Chivukula, Mamatha; Choksi, Neha Desai; Ganott, Marie A.; Sumkin, Jules H.

doi:10.2214/ajr.11.7712

Cited by 32 publications

(11 citation statements)

References 27 publications

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“…As in most settings, it is best to treat each individual patient by using a multidisciplinary approach, assessing risk factors, clinical parameters, and radiographic and pathologic findings. Based on our data and those of Lee et al, 16 it appears reasonable for patients with small (and particularly if also incidental) radial scars to be managed conservatively, provided there is good pathologic-radiographic concordance. …”

Section: Commentsupporting

confidence: 73%

“…3,6,7,16 It is also worthy to note that even the high-risk lesions (LCIS, ADH, ALH) considered as pathologic upgrades could, themselves, be considered incidental microscopic findings, as they would have remained clinically occult had an excisional biopsy not been performed in these cases.…”

Section: Commentmentioning

confidence: 99%

“…Lee et al 16 studied the outcome of patients diagnosed with microscopic radial scars and papillomas in NCBs who underwent excision. In their analysis, none of 18 microscopic radial scars revealed malignancy (invasive carcinoma or DCIS) on follow-up excision, while 7 cases showed a high-risk lesion on excision (6 ADH, 1 atypical apocrine adenosis).…”

Section: Commentmentioning

confidence: 99%

“…Another strength of this study is the detailed pathologic correlation that is generally lacking from many published studies examining this clinical scenario. 5,8,16 Our study is among few based on a cohort of patients with histopathologically confirmed radial scars. While it is intuitively obvious to maintain a pure study group, this necessary step is not performed in all studies.…”

Section: Commentmentioning

confidence: 99%

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Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases

Matrai¹,

D’Alfonso²,

Drotman³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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Context Radial scars are benign sclerosing lesions that are routinely excised when diagnosed in a needle core biopsy. Optimal management for patients with incidental and small (≤5 mm) radial scars is uncertain. Objective To assess pathologic upgrade of radial scars diagnosed in needle core biopsy samples and identify a subset of patients who could benefit from conservative management. Design Patients with a diagnosis of radial scar in a needle core biopsy who underwent excision of the biopsied area were identified. Radial scars greater than 5 mm in size and those with coexisting atypia, carcinoma, and papillary lesions were excluded. After histologic-radiographic correlation, rates of pathologic upgrade were assessed. Results Seventy-seven radial scars diagnosed in 66 patients were included. Overall, 9 of 77 (12%) showed upgrade to a high-risk lesion (6 lobular carcinoma in situ, 2 atypical ductal hyperplasia, 1 atypical lobular hyperplasia), while none (0%) showed upgrade to invasive carcinoma or ductal carcinoma in situ. One of 22 incidental radial scars (4.5%) showed upgrade on excision versus 6 of 36 (16.7%) for radial scars considered to be the radiographic target (P = .23). Older age was associated with upgrade (P < .001). Conclusions No incidental or small (≤5 mm) radial scars excised revealed invasive carcinoma or ductal carcinoma in situ on excision. Provided there is good pathologic-radiologic concordance, it appears reasonable for these patients to be managed conservatively.

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Section: Commentsupporting

confidence: 73%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases

Matrai¹,

D’Alfonso²,

Drotman³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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“…[4, 7, 9] The average size of radial scars associated with cancer was reported as 1.4 cm [2, 10, 24]. Some groups did not find cancer when the RS was an incidental microscopic finding.…”

Section: Discussionmentioning

confidence: 99%

Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution

Nassar

Conners

Çelik

et al. 2015

Annals of Diagnostic Pathology

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Background Radial scars (RS) or complex sclerosing lesions (CSL) of the breast are benign radiological and histological entities. Radiologically, they appear as architectural distortion with central radiolucency. These stellate lesions are frequently identified on screening mammography and, with the introduction of population-based screening programs; their incidence has increased to 0.03%–0.09% of all core needle biopsies (CNB). However, they can pose diagnostic difficulty as their radiologic and histologic appearance mimic carcinoma. Because of the high incidence of atypia or associated occult malignancy, the current literature recommendation is excision of all mammographically detected RS/CSL diagnosed on CNB. Aims and Objective Our aim was to review all RS/CSL that were previously diagnosed on image-guided CNB from January 1st, 1994 to August 31st, 2013, and assess the pathology from the excisional biopsy to identify cases upstaged to atypia or neoplasm. Results There were a total of 113 CNB from 109 women with radial scar without concomitant atypia on CNB diagnosed during that period; five cases were excluded because of concurrent cancer. Average age of these women was 52.9 years (range: 23.0 – 82.0 years). Thirty-five women (38/100 CNB; 38.0%) have follow-up excision. The median size of the excised radial scars is 1.2 cm (range: 0.4 – 3.3 cm). More than two-thirds of excised cases (68.6%; 24/35) were greater than 1.0 cm. The mammographic and ultrasonographic imaging features were listed as architectural distortion in 53.1% (17/32) and hypoechoic nodules with irregular margins in 36.4% (12/33) respectively. Almost all excised cases 91.7%; 33/36) showed radiologic and pathologic concordance, and more than three-quarters (23/29; 79.3%) are designated as Bi-Rads level 4 (suspicious for malignancy). The 38 follow-up excisional biopsies revealed: 2 (5.3%) invasive mammary carcinomas (2 metaplastic carcinomas including adenoid cystic carcinoma); 2 (5.3%) in-situ ductal carcinoma; 1 (2.6%) lobular carcinoma in-situ; 5 (13.2%) atypical lobular hyperplasia; 1 (2.6%) atypical ductal hyperplasia; 22 (57.9%) residual radial scars; and 5 (13.2%) with no residual lesions on follow-up. Conclusion Follow-up excisional biopsy is warranted for RS/CSL specifically if they are larger than 1.0 cm with worrisome radiographic images or showed radiologic and pathologic discordance, as approximately 29% (11/38) of these cases will have an upgrade to in-situ or invasive carcinomas or other high risk lesions on follow-up.

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Imaging Pathological Correlation in Breast Imaging

Shetty

2014

Breast Cancer Screening and Diagnosis

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Risk of Malignancy When Microscopic Radial Scars and Microscopic Papillomas Are Found at Percutaneous Biopsy

Cited by 32 publications

References 27 publications

Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases

Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases

Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution

Imaging Pathological Correlation in Breast Imaging

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