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Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases.
Arch Pathol Lab Med. 2015 Sep; 139(9):1137-42.AP

Abstract

CONTEXT

Radial scars are benign sclerosing lesions that are routinely excised when diagnosed in a needle core biopsy. Optimal management for patients with incidental and small (≤5 mm) radial scars is uncertain.

OBJECTIVE

To assess pathologic upgrade of radial scars diagnosed in needle core biopsy samples and identify a subset of patients who could benefit from conservative management.

DESIGN

Patients with a diagnosis of radial scar in a needle core biopsy who underwent excision of the biopsied area were identified. Radial scars greater than 5 mm in size and those with coexisting atypia, carcinoma, and papillary lesions were excluded. After histologic-radiographic correlation, rates of pathologic upgrade were assessed.

RESULTS

Seventy-seven radial scars diagnosed in 66 patients were included. Overall, 9 of 77 (12%) showed upgrade to a high-risk lesion (6 lobular carcinoma in situ, 2 atypical ductal hyperplasia, 1 atypical lobular hyperplasia), while none (0%) showed upgrade to invasive carcinoma or ductal carcinoma in situ. One of 22 incidental radial scars (4.5%) showed upgrade on excision versus 6 of 36 (16.7%) for radial scars considered to be the radiographic target (P = .23). Older age was associated with upgrade (P < .001).

CONCLUSIONS

No incidental or small (≤5 mm) radial scars excised revealed invasive carcinoma or ductal carcinoma in situ on excision. Provided there is good pathologic-radiologic concordance, it appears reasonable for these patients to be managed conservatively.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Matrai C
No affiliation info available
D'Alfonso TM
No affiliation info available
Pharmer L
No affiliation info available
Drotman MB
No affiliation info available
Simmons RM
No affiliation info available
Shin SJ
From the Departments of Pathology and Laboratory Medicine (Drs Matrai, D'Alfonso, and Shin), Breast Surgery (Drs Pharmer and Simmons), and Radiology-Division of Women's Imaging (Dr Drotman), Weill Cornell Medical College, New York, New York. Drs Matrai and D'Alfonso contributed equally to this study.

MeSH

AdultAgedBiopsy, Large-Core NeedleBreast DiseasesBreast NeoplasmsCalcinosisCarcinoma, Ductal, BreastCarcinoma, Intraductal, NoninfiltratingCarcinoma, LobularCicatrixFemaleHumansHyperplasiaMiddle AgedRadiographyRetrospective Studies

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25607999

Citation

Matrai, Cathleen, et al. "Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: a Study of 77 Cases." Archives of Pathology & Laboratory Medicine, vol. 139, no. 9, 2015, pp. 1137-42.
Matrai C, D'Alfonso TM, Pharmer L, et al. Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases. Arch Pathol Lab Med. 2015;139(9):1137-42.
Matrai, C., D'Alfonso, T. M., Pharmer, L., Drotman, M. B., Simmons, R. M., & Shin, S. J. (2015). Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases. Archives of Pathology & Laboratory Medicine, 139(9), 1137-42. https://doi.org/10.5858/arpa.2014-0550-OA
Matrai C, et al. Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: a Study of 77 Cases. Arch Pathol Lab Med. 2015;139(9):1137-42. PubMed PMID: 25607999.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases. AU - Matrai,Cathleen, AU - D'Alfonso,Timothy M, AU - Pharmer,Lindsay, AU - Drotman,Michele B, AU - Simmons,Rache M, AU - Shin,Sandra J, Y1 - 2015/01/21/ PY - 2015/1/22/entrez PY - 2015/1/22/pubmed PY - 2015/12/15/medline SP - 1137 EP - 42 JF - Archives of pathology & laboratory medicine JO - Arch Pathol Lab Med VL - 139 IS - 9 N2 - CONTEXT: Radial scars are benign sclerosing lesions that are routinely excised when diagnosed in a needle core biopsy. Optimal management for patients with incidental and small (≤5 mm) radial scars is uncertain. OBJECTIVE: To assess pathologic upgrade of radial scars diagnosed in needle core biopsy samples and identify a subset of patients who could benefit from conservative management. DESIGN: Patients with a diagnosis of radial scar in a needle core biopsy who underwent excision of the biopsied area were identified. Radial scars greater than 5 mm in size and those with coexisting atypia, carcinoma, and papillary lesions were excluded. After histologic-radiographic correlation, rates of pathologic upgrade were assessed. RESULTS: Seventy-seven radial scars diagnosed in 66 patients were included. Overall, 9 of 77 (12%) showed upgrade to a high-risk lesion (6 lobular carcinoma in situ, 2 atypical ductal hyperplasia, 1 atypical lobular hyperplasia), while none (0%) showed upgrade to invasive carcinoma or ductal carcinoma in situ. One of 22 incidental radial scars (4.5%) showed upgrade on excision versus 6 of 36 (16.7%) for radial scars considered to be the radiographic target (P = .23). Older age was associated with upgrade (P < .001). CONCLUSIONS: No incidental or small (≤5 mm) radial scars excised revealed invasive carcinoma or ductal carcinoma in situ on excision. Provided there is good pathologic-radiologic concordance, it appears reasonable for these patients to be managed conservatively. SN - 1543-2165 UR - https://www.unboundmedicine.com/medline/citation/25607999/Advocating_Nonsurgical_Management_of_Patients_With_Small_Incidental_Radial_Scars_at_the_Time_of_Needle_Core_Biopsy:_A_Study_of_77_Cases_ DB - PRIME DP - Unbound Medicine ER -