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Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution.
Ann Diagn Pathol. 2015 Feb; 19(1):24-8.AD

Abstract

Radial scars (RSs) or complex sclerosing lesions (CSLs) of the breast are benign radiologic and histologic entities. With the introduction of population-based screening programs, their incidence has increased to 0.03% to 0.09% of all core needle biopsies (CNBs). They can pose diagnostic difficulty because their radiologic and histologic appearances mimic carcinoma. We retrospectively searched for and reviewed all cases of RS/CSL diagnosed on image-guided CNB from January 1, 1994, to August 31, 2013, at a single institution. We also assessed the pathologic reports from excisional biopsies to identify cases upstaged to atypia or neoplasm. After exclusions, 100 CNBs were identified from 97 women, which showed RS/CSL without concomitant atypia. Mean age of the women was 52.9 years. Thirty-five women (38/100 CNBs, 38%) had follow-up excision. The median size of the excised RS/CSLs was 1.2 cm; 69% were larger than 1.0 cm. Almost all excised cases (92%) showed radiologic and pathologic concordance, and 79% were designated as suspicious for malignancy (Breast Imaging Reporting and Data System level 4). The most common findings of 38 follow-up excisional biopsies were residual RS (22 [58%]), atypical lobular hyperplasia (5 [13%]), and no residual lesion (5 [13%]). Eleven excisional biopsies (29%) were upstaged to invasive or in situ carcinoma or to atypical hyperplasia. Follow-up excisional biopsy is warranted for RS/CSLs, specifically those larger than 1.0 cm with worrisome radiographic findings or with radiologic and pathologic discordance. Approximately 29% of cases were upstaged to in situ or invasive carcinomas or other high-risk lesions in our study.

Authors+Show Affiliations

Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, FL. Electronic address: nassar.aziza@mayo.edu.Department of Radiology, Mayo Clinic, Rochester, MN.Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, FL.Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25578683

Citation

Nassar, Aziza, et al. "Radial Scar/complex Sclerosing Lesions: a Clinicopathologic Correlation Study From a Single Institution." Annals of Diagnostic Pathology, vol. 19, no. 1, 2015, pp. 24-8.
Nassar A, Conners AL, Celik B, et al. Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution. Ann Diagn Pathol. 2015;19(1):24-8.
Nassar, A., Conners, A. L., Celik, B., Jenkins, S. M., Smith, C. Y., & Hieken, T. J. (2015). Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution. Annals of Diagnostic Pathology, 19(1), 24-8. https://doi.org/10.1016/j.anndiagpath.2014.12.003
Nassar A, et al. Radial Scar/complex Sclerosing Lesions: a Clinicopathologic Correlation Study From a Single Institution. Ann Diagn Pathol. 2015;19(1):24-8. PubMed PMID: 25578683.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution. AU - Nassar,Aziza, AU - Conners,Amy L, AU - Celik,Betul, AU - Jenkins,Sarah M, AU - Smith,Carin Y, AU - Hieken,Tina J, Y1 - 2014/12/20/ PY - 2014/08/22/received PY - 2014/10/23/revised PY - 2014/12/16/accepted PY - 2015/1/13/entrez PY - 2015/1/13/pubmed PY - 2015/9/1/medline KW - Breast cancer KW - Core needle biopsy KW - Excisional biopsy KW - Radial scar KW - Upstage SP - 24 EP - 8 JF - Annals of diagnostic pathology JO - Ann Diagn Pathol VL - 19 IS - 1 N2 - Radial scars (RSs) or complex sclerosing lesions (CSLs) of the breast are benign radiologic and histologic entities. With the introduction of population-based screening programs, their incidence has increased to 0.03% to 0.09% of all core needle biopsies (CNBs). They can pose diagnostic difficulty because their radiologic and histologic appearances mimic carcinoma. We retrospectively searched for and reviewed all cases of RS/CSL diagnosed on image-guided CNB from January 1, 1994, to August 31, 2013, at a single institution. We also assessed the pathologic reports from excisional biopsies to identify cases upstaged to atypia or neoplasm. After exclusions, 100 CNBs were identified from 97 women, which showed RS/CSL without concomitant atypia. Mean age of the women was 52.9 years. Thirty-five women (38/100 CNBs, 38%) had follow-up excision. The median size of the excised RS/CSLs was 1.2 cm; 69% were larger than 1.0 cm. Almost all excised cases (92%) showed radiologic and pathologic concordance, and 79% were designated as suspicious for malignancy (Breast Imaging Reporting and Data System level 4). The most common findings of 38 follow-up excisional biopsies were residual RS (22 [58%]), atypical lobular hyperplasia (5 [13%]), and no residual lesion (5 [13%]). Eleven excisional biopsies (29%) were upstaged to invasive or in situ carcinoma or to atypical hyperplasia. Follow-up excisional biopsy is warranted for RS/CSLs, specifically those larger than 1.0 cm with worrisome radiographic findings or with radiologic and pathologic discordance. Approximately 29% of cases were upstaged to in situ or invasive carcinomas or other high-risk lesions in our study. SN - 1532-8198 UR - https://www.unboundmedicine.com/medline/citation/25578683/Radial_scar/complex_sclerosing_lesions:_a_clinicopathologic_correlation_study_from_a_single_institution_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1092-9134(14)00133-6 DB - PRIME DP - Unbound Medicine ER -