Abstract
PurposeRadial scar and radial sclerosis (RS) are considered benign breast lesions with proliferative features. There is sparse literature on frequency of cancer upgrade in these patients without atypical features found on image-guided needle biopsy. This study retrospectively reviews cases of isolated RS diagnosed on needle biopsy and evaluates the cancer upgrade after subsequent surgical excision.MethodsWe conducted a retrospective cross-sectional study of cases with an isolated RS diagnosis based on needle biopsy and subsequent surgical pathology among all patients between January 1, 2009 and December 31, 2013. Patients with concomitant atypia, lobular carcinoma in situ on core biopsy, complete excision of very small RS with needle biopsy, and radiology-pathology discordance were excluded. An upgrade from the needle biopsy of RS was defined as surgical excision pathology that revealed ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), and/or invasive lobular carcinoma (ILC).Results10,921 image-guided needle biopsy pathology reports were collected and 88 patients (0.81 %) were identified as having isolated RS. Of these 88 patients, 63 (72 %) underwent excision. The upgrade rate to cancer on subsequent surgical excision was 1.59 % (1/63) for DCIS; 0 % (0/63) for IDC; and 0 % (0/63) ILC. Twenty-five patients who did not undergo surgical excision had stable imaging studies with mean (±SD) 26 (±20) months follow up.ConclusionsIsolated radial scar on needle biopsy may not warrant routine surgical excision given relatively low cancer upgrade rates. Advancement in breast imaging, pathology and multidisciplinary approaches to care may effectively guide non-surgical management of RS.
Highlights
Breast cancer is the most common cancer diagnosed and the second leading cause of cancer-related deaths in women in the United States (Howlader et al 2011)
1020 practicing breast surgeons were asked about their preferred management of these breast lesions, including atypical lobular hyperplasia, atypical ductal hyperplasia, lobular carcinoma in situ (LCIS), flat epithelial atypia, radial scar and papilloma without atypia (Krishnamurthy et al 2012)
Surgical excisional biopsy was recommended in approximately 63 % of cases for papilloma without atypia, 75 % for atypical lobular hyperplasia, 70 % for LCIS, 72 % for flat epithelial atypia, and 76 % for radial scar (Krishnamurthy et al 2012)
Summary
Breast cancer is the most common cancer diagnosed and the second leading cause of cancer-related deaths in women in the United States (Howlader et al 2011). Women with a history of benign breast disease (BBD) are at an increased risk for developing breast cancer. Surgical excisional biopsy was recommended in approximately 63 % of cases for papilloma without atypia, 75 % for atypical lobular hyperplasia, 70 % for LCIS, 72 % for flat epithelial atypia, and 76 % for radial scar (Krishnamurthy et al 2012). These variations of practice pattern are due to lack of robust research outcome studies
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