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

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.

[1]  C. Catalano,et al.  Radial Scars of the Breast: Contrast‐enhanced Magnetic Resonance Mammography Appearance , 2005, The breast journal.

[2]  Eun-Kyung Kim.  RE: Papillary Thyroid Carcinoma Treated with Radiofrequency Ablation in a Patient with Hypertrophic Cardiomyopathy: A Case Report , 2016, Korean journal of radiology.

[3]  C. Lehman,et al.  Frequency and upgrade rates of atypical ductal hyperplasia diagnosed at stereotactic vacuum-assisted breast biopsy: 9-versus 11-gauge. , 2009, AJR. American journal of roentgenology.

[4]  L. Livi,et al.  Radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy: analysis of 49 cases from a single-centre and review of the literature. , 2012, Breast.

[5]  J. Silverman,et al.  Follow-up Surgical Excision Is Indicated When Breast Core Needle Biopsies Show Atypical Lobular Hyperplasia or Lobular Carcinoma In Situ: A Correlative Study of 33 Patients With Review of the Literature , 2005, The American journal of surgical pathology.

[6]  W. Berg.  Image-guided breast biopsy and management of high-risk lesions. , 2004, Radiologic clinics of North America.

[7]  W. Yang,et al.  Management of radial sclerosing lesions of the breast diagnosed using percutaneous vacuum-assisted core needle biopsy: recommendations for excision based on seven years’ of experience at a single institution , 2011, Breast Cancer Research and Treatment.

[8]  A. Razek,et al.  Invasive ductal carcinoma: correlation of apparent diffusion coefficient value with pathological prognostic factors , 2010, NMR in biomedicine.

[9]  Phoebe E. Freer,et al.  Surgical excision of radial scars diagnosed by core biopsy may help predict future risk of breast cancer , 2014, Breast Cancer Research and Treatment.

[10]  H. Kuerer,et al.  Multidisciplinary considerations in the management of high-risk breast lesions. , 2012, AJR. American journal of roentgenology.

[11]  L. Liberman,et al.  Breast imaging reporting and data system (BI-RADS). , 2002, Radiologic clinics of North America.

[12]  Min Jung Kim,et al.  Mammographically Occult Asymptomatic Radial Scars/Complex Sclerosing Lesions at Ultrasonography-Guided Core Needle Biopsy: Follow-Up Can Be Recommended. , 2016, Ultrasound in medicine & biology.

[13]  A. Soran,et al.  Rationale of Excisional Biopsy After the Diagnosis of Benign Radial Scar on Core Biopsy: A Single Institutional Outcome Analysis , 2013, American journal of clinical oncology.

[14]  X. Teng,et al.  Papillary Thyroid Carcinoma Treated with Radiofrequency Ablation in a Patient with Hypertrophic Cardiomyopathy: A Case Report , 2016, Korean journal of radiology.

[15]  Robert E. Brown,et al.  Field effect in cancer-an update. , 2009, Annals of clinical and laboratory science.

[16]  M. Latour,et al.  Management of radial scars found at percutaneous breast biopsy. , 2006, Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes.

[17]  K. Mokbel,et al.  Radial scar and carcinoma of the breast: microscopic findings in 32 cases. , 1999, Breast.

[18]  G. Osborn,et al.  A review of needle core biopsy diagnosed radial scars in the Welsh Breast Screening Programme. , 2011, Annals of the Royal College of Surgeons of England.

[19]  M. Espié,et al.  [Diffusion-weighted MR imaging of the breast]. , 2010, Journal de radiologie.

[20]  A. Lopez-Medina,et al.  Radial scars diagnosed at stereotactic core-needle biopsy: surgical biopsy findings , 2006, European Radiology.

[21]  D. Georgian-Smith,et al.  Variations in physician recommendations for surgery after diagnosis of a high-risk lesion on breast core needle biopsy. , 2012, AJR. American journal of roentgenology.

[22]  J. Sloane,et al.  Carcinoma and atypical hyperplasia in radial scars and complex sclerosing lesions: importance of lesion size and patient age , 1993, Histopathology.

[23]  Role of sonography in evaluation of radial scars of the breast. , 2000, AJR. American journal of roentgenology.

[24]  R. Simmons,et al.  Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases. , 2015, Archives of pathology & laboratory medicine.

[25]  W. P. Evans,et al.  Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? , 2002, AJR. American journal of roentgenology.

[26]  A. Nassar,et al.  Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution. , 2015, Annals of diagnostic pathology.

[27]  B. Calhoun,et al.  Radial scars diagnosed on breast core biopsy: Frequency of atypia and carcinoma on excision and implications for management. , 2016, Breast.

[28]  C. Griffith,et al.  All radial scars/complex sclerosing lesions seen on breast screening mammograms should be excised. , 2005, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[29]  M. Newell,et al.  Radial Scars of the Breast Encountered at Core Biopsy: Review of Histologic, Imaging, and Management Considerations. , 2017, AJR. American journal of roentgenology.

[30]  C. Zuiani,et al.  Nonsurgical management of high-risk lesions diagnosed at core needle biopsy: can malignancy be ruled out safely with breast MRI? , 2012, AJR. American journal of roentgenology.

[31]  J. Meyer,et al.  Evaluation of nonpalpable solid breast masses with stereotaxic large-needle core biopsy using a dedicated unit. , 1996, AJR. American journal of roentgenology.

[32]  A. Razek,et al.  Assessment of axillary lymph nodes in patients with breast cancer with diffusion-weighted MR imaging in combination with routine and dynamic contrast MR imaging , 2016, Breast Cancer.

[33]  C. Nickson,et al.  Variation in mammographic appearance between projections of small breast cancers compared with radial scars , 2010, Journal of medical imaging and radiation oncology.

[34]  Zaibo Li,et al.  Surgical excision outcome after radial scar without atypical proliferative lesion on breast core needle biopsy: a single institutional analysis. , 2016, Annals of diagnostic pathology.

[35]  T. Brown,et al.  Atypical Ductal Hyperplasia: Improved Accuracy with the 11-Gauge Vacuum-Assisted versus the 14-Gauge Core Biopsy Needle , 2007, Annals of Surgical Oncology.

[36]  D. Sgroi,et al.  Sclerosing lesions of the breast. , 2004, Seminars in diagnostic pathology.

[37]  V. Eusebi,et al.  Epitheliosis, infiltrating epitheliosis, and radial scar. , 2010, Seminars in diagnostic pathology.

[38]  J. Kaplan,et al.  Radial Scar at Image-guided Needle Biopsy: Is Excision Necessary? , 2015, The American journal of surgical pathology.

[39]  C. R. Leemans,et al.  A genetic explanation of Slaughter's concept of field cancerization: evidence and clinical implications. , 2003, Cancer research.

[40]  S. Steele,et al.  The Treatment of Radial Scars in the Modern Era—Surgical Excision is not Required , 2010, The American surgeon.

[41]  B. Pockaj,et al.  Atypical Ductal Hyperplasia on Core Biopsy: An Automatic Trigger for Excisional Biopsy? , 2012, Annals of Surgical Oncology.

[42]  C. Zuiani,et al.  Radial scars without atypia diagnosed at imaging-guided needle biopsy: how often is associated malignancy found at subsequent surgical excision, and do mammography and sonography predict which lesions are malignant? , 2010, AJR. American journal of roentgenology.