Abstract
To evaluate the underestimation rate in breast surgical biopsy after the diagnosis of radial scar/complex sclerosing lesion through percutaneous biopsy. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The PubM: ed, SciELO, Cochrane, and Embase databases were consulted, with searches conducted through November 2020, using specific keywords (radial scar OR: complex sclerosing lesion, breast cancer, anatomopathological percutaneous biopsy AND/OR: surgical biopsy). Study selection was conducted by two researchers experienced in preparing systematic reviews. The eight selected articles were fully read, and a comparative analysis was performed. A total of 584 studies was extracted, 8 of which were selected. One of them included women who had undergone a percutaneous biopsy with a histological diagnosis of radial scar/complex sclerosing lesion and subsequently underwent surgical excision; the results were used to assess the underestimation rate of atypical and malignant lesions. The overall underestimation rate in the 8 studies ranged from 1.3 to 40% and the invasive lesion underestimation rate varied from 0 to 10.5%. The histopathological diagnosis of a radial scar/complex sclerosing lesion on the breast is not definitive, and it may underestimate atypical and malignant lesions, which require a different treatment, making surgical excision an important step in diagnostic evaluation.
Highlights
IntroductionRadial scar/complex sclerosing lesion (RS/CSL) is a benign breast disease, characterized macroscopically by an architectural distortion of the breast tissue with radial spikes in the center and, microscopically, by a central area of fibroelastosis from which ducts and lobes radiate. The distinction between both nomenclatures is based only on the size of the lesion: the radial scar measures < 1 cm and the complex sclerosing lesion is > 1 cm. Most are microscopic, multiple, bilateral, and not palpable on clinical examination.The implementation of screening programs and the consequent increase in the number of asymptomatic patients undergoing mammography contributed to a 3-fold increase in the detection of these lesions in percutaneous biopsies. Due to its radiological and histological similarity to invasive cancer and its association with other atypical lesions, RS/CSL arouses the interest of researchers; the real need for surgical excision is questioned in view of a histopathological diagnosis enabled by percutaneous biopsy.Once a histological diagnosis is reached after a percutaneous biopsy, the potential for intrinsic malignancy of the lesion must be considered
Due to its radiological and histological similarity to invasive cancer and its association with other atypical lesions, Radial scar/complex sclerosing lesion (RS/CSL) arouses the interest of researchers; the real need for surgical excision is questioned in view of a histopathological diagnosis enabled by percutaneous biopsy
The main reasons for exclusion were the following: studies unrelated to the main objective of our review, type of studies, duplicate articles, and articles not written in English or Portuguese
Summary
Radial scar/complex sclerosing lesion (RS/CSL) is a benign breast disease, characterized macroscopically by an architectural distortion of the breast tissue with radial spikes in the center and, microscopically, by a central area of fibroelastosis from which ducts and lobes radiate. The distinction between both nomenclatures is based only on the size of the lesion: the radial scar measures < 1 cm and the complex sclerosing lesion is > 1 cm. Most are microscopic, multiple, bilateral, and not palpable on clinical examination.The implementation of screening programs and the consequent increase in the number of asymptomatic patients undergoing mammography contributed to a 3-fold increase in the detection of these lesions in percutaneous biopsies. Due to its radiological and histological similarity to invasive cancer and its association with other atypical lesions, RS/CSL arouses the interest of researchers; the real need for surgical excision is questioned in view of a histopathological diagnosis enabled by percutaneous biopsy.Once a histological diagnosis is reached after a percutaneous biopsy, the potential for intrinsic malignancy of the lesion must be considered. Radial scar/complex sclerosing lesion (RS/CSL) is a benign breast disease, characterized macroscopically by an architectural distortion of the breast tissue with radial spikes in the center and, microscopically, by a central area of fibroelastosis from which ducts and lobes radiate.. Radial scar/complex sclerosing lesion (RS/CSL) is a benign breast disease, characterized macroscopically by an architectural distortion of the breast tissue with radial spikes in the center and, microscopically, by a central area of fibroelastosis from which ducts and lobes radiate.1,2 The distinction between both nomenclatures is based only on the size of the lesion: the radial scar measures < 1 cm and the complex sclerosing lesion is > 1 cm.. Due to its radiological and histological similarity to invasive cancer and its association with other atypical lesions, RS/CSL arouses the interest of researchers; the real need for surgical excision is questioned in view of a histopathological diagnosis enabled by percutaneous biopsy. Its coexistence with cancer and other high-risk lesions should be taken into account. the pathogenesis of the lesion, as well as the reason the radial scar is associated with an increased risk of breast cancer, is still uncertain.
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