Outcome of radial scar/complex sclerosing lesion associated with epithelial proliferations with atypia diagnosed on breast core biopsy – Results from a multicentric UK based study

AIMS: The clinical significance of radial scar/complex sclerosing lesion (RS/CSL) with high risk lesions (epithelial atypia) diagnosed on needle core biopsy (NCB) is not well defined. We aimed at assessing the upgrade rate to carcinoma in-situ (DCIS) and invasive on the surgical excision specimen in a large cohort of RS/CSL associated with atypia. METHODS: 161 women with NCB diagnosis of a RS/CSL with atypia and follow-up histology were studied. Histological findings including different forms of the atypical lesions and final histological outcome in the excision specimens were retrieved and analysed and the upgrade rate for malignancy and invasive carcinoma calculated. RESULTS: 76% of the cases were associated with an atypical ductal hyperplasia (ADH) whereas lobular neoplasia was seen in 24%. On final histology 38 cases were malignant (overall upgrade rate of 25%); 12 invasive and 27 DCIS. The upgrade differed according to the type of atypia and was highest for ADH (35%). When associated with lobular neoplasia the upgrade rate was 12%. The upgrade rates variability was also considerably lower and showing less variability when considering the upgrade to invasive carcinoma alone. CONCLUSION: The upgrade rate for ADH diagnosed on NCB with RS is similar to that of ADH without RS and therefore should be managed similarly. RS associated with LN is less frequently associated with malignant outcome. Most lesions exhibiting some degree of atypia showed similar upgrade rate to invasive carcinoma. Management of RS should be based on the concurrent atypical lesion.

[1]  E. Morris,et al.  Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) , 2018, Breast Cancer Research and Treatment.

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

[3]  P. Tartter,et al.  Radial Scar at Percutaneous Breast Biopsy That Does Not Require Surgery. , 2016, Journal of the American College of Surgeons.

[4]  L. Bassett,et al.  Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review , 2016, Modern Pathology.

[5]  E. Morris,et al.  First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) , 2016, Breast Cancer Research and Treatment.

[6]  Chengquan Zhao,et al.  Pathologic findings of follow-up surgical excision for radial scar on breast core needle biopsy. , 2016, Human pathology.

[7]  R. Kubik-Huch,et al.  Lesions with unclear malignant potential (B3) after minimally invasive breast biopsy: evaluation of vacuum biopsies performed in Switzerland and recommended further management , 2015, Acta radiologica.

[8]  Greg Ogrinc,et al.  Squire 2.0 (Standards for Quality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. , 2015, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[9]  K. Horgan,et al.  Outcome of a new patient pathway for managing B3 breast lesions by vacuum-assisted biopsy: time to change current UK practice? , 2015, Journal of Clinical Pathology.

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

[11]  J. Elmore,et al.  Diagnostic concordance among pathologists interpreting breast biopsy specimens. , 2015, JAMA.

[12]  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.

[13]  I. Amendoeira,et al.  Improved malignancy prediction by B3 breast lesions subclassification. , 2013, Annals of diagnostic pathology.

[14]  Charles G Luedtke,et al.  Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy , 2013, Cancer.

[15]  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.

[16]  Sunil R. Lakhani,et al.  WHO classification of tumours of the breast , 2012 .

[17]  I. Ellis,et al.  Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening , 2011, International journal of cancer.

[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]  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.

[20]  I. Ellis,et al.  Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening , 2008, Histopathology.

[21]  I. Ellis,et al.  The significance of lobular neoplasia on needle core biopsy of the breast , 2008, Virchows Archiv.

[22]  Consumer Protection,et al.  European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition--summary document. , 2008, Annals of oncology : official journal of the European Society for Medical Oncology.

[23]  M. Dillon,et al.  Predictive Value of Breast Lesions of “Uncertain Malignant Potential” and “Suspicious for Malignancy” Determined by Needle Core Biopsy , 2007, Annals of Surgical Oncology.

[24]  F. O'Malley,et al.  The Spectrum of Apocrine Lesions of the Breast , 2004, Advances in anatomic pathology.

[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]  G. Colditz,et al.  Radial scars in benign breast-biopsy specimens and the risk of breast cancer. , 1999, The New England journal of medicine.