Radial scar on image-guided breast biopsy: is surgical excision necessary?

Wendy Yen Yun Chou,Rebecca Aft,Deborah J Veis

doi:10.1007/s10549-018-4741-y

Wendy Yen Yun Chou, Rebecca Aft + Show 1 more

Open Access

https://doi.org/10.1007/s10549-018-4741-y

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Abstract

PurposeRadial scar’s stellate appearance may mimic carcinoma mammographically and histologically. Management of radial scar (RS) found on breast core needle biopsies (CNB) ranges from excision to clinical observation due to the variation in reported upgrades to malignancy at surgical excision. We examined the upgrade rate in patients with RS detected on CNB at our institution and reviewed the current literature.MethodsA retrospective study was conducted of all cases with RS diagnosed on CNB between December 2006 and March 2017 at our institution. Inclusion criteria were patients with “pure” RS and RS associated with high-risk lesions (HRL). Upgrade was defined as invasive or non-invasive cancer in the excisional biopsy.Results157 cases were identified with RS on CNB, and 122 cases met inclusion criteria. Of these 122 cases, 91 (75%) had pure RS on CNB while 31 (25%) had associated atypia or HRL. 81 (66%) of patients proceeded to excisional biopsy and 41 (34%) did not. Two patients (1.6% of total) were found to have a low-grade invasive ductal carcinoma (0.6 and 0.8 cm) upon surgical excision. None of the remaining 120 patients developed an ipsilateral breast cancer with a mean of 32.3-month follow-up.ConclusionsWe found a very low upgrade rate to breast cancer when RS was found on CNB with or without associated HRL. Our results are consistent with other reported series. Our data do not support surgical excision for RS but rather close clinical follow-up for patients with RS on CNB.

Highlights

Radial scars (RS) are entities which are described mammographically and pathologically
Exclusion criteria were RS associated with malignancy at percutaneous biopsy, patients with simultaneous or previous ipsilateral breast cancer diagnosis within 6 months prior to core needle biopsies (CNB), patients who were lost to follow up as defined by last follow-up date corresponding to the date of the CNB, and patients who were never physically seen at our medical center, though their pathology was reviewed at our institution
RS was identified on 157 image-guided CNB. 35 cases were excluded from this study due to simultaneous ipsilateral breast cancer, lost to follow up, or never seen at our medical center (Supplemental Table 1)

Summary

Introduction

Radial scars (RS) are entities which are described mammographically and pathologically. They are benign breast lesions that are commonly detected by pathologists [1]. The risk of subsequent breast cancer associated with RS found on pathology with and without atypia ranges from 1.1–3.0 to 2.8–6.7% respectively [2]. Patients with RS in benign breast biopsies were found to have twice as great risk of subsequent breast cancer [1, 3]. RS are characterized by an area of architectural distortion with a central radiolucency and the presence of radiating spicules. RS are characterized by a central fibroelastic core containing entrapped glandular elements and ducts that radiate outward giving the lesion a characteristic stellate appearance. Histologic and radiographic RS do not have an exact correspondence [4,5,6]

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