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Isolated radial scar diagnosis by core-needle biopsy: Is surgical excision necessary?
Springerplus. 2016; 5:398.S

Abstract

PURPOSE

Radial scar and radial sclerosis (RS) are considered benign breast lesions with proliferative features. There is sparse literature on frequency of cancer upgrade in these patients without atypical features found on image-guided needle biopsy. This study retrospectively reviews cases of isolated RS diagnosed on needle biopsy and evaluates the cancer upgrade after subsequent surgical excision.

METHODS

We conducted a retrospective cross-sectional study of cases with an isolated RS diagnosis based on needle biopsy and subsequent surgical pathology among all patients between January 1, 2009 and December 31, 2013. Patients with concomitant atypia, lobular carcinoma in situ on core biopsy, complete excision of very small RS with needle biopsy, and radiology-pathology discordance were excluded. An upgrade from the needle biopsy of RS was defined as surgical excision pathology that revealed ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), and/or invasive lobular carcinoma (ILC).

RESULTS

10,921 image-guided needle biopsy pathology reports were collected and 88 patients (0.81 %) were identified as having isolated RS. Of these 88 patients, 63 (72 %) underwent excision. The upgrade rate to cancer on subsequent surgical excision was 1.59 % (1/63) for DCIS; 0 % (0/63) for IDC; and 0 % (0/63) ILC. Twenty-five patients who did not undergo surgical excision had stable imaging studies with mean (±SD) 26 (±20) months follow up.

CONCLUSIONS

Isolated radial scar on needle biopsy may not warrant routine surgical excision given relatively low cancer upgrade rates. Advancement in breast imaging, pathology and multidisciplinary approaches to care may effectively guide non-surgical management of RS.

Authors+Show Affiliations

Sutter Medical Group, Sacramento, CA USA ; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA ; Sutter Institute for Medical Research, Sacramento, CA USA.Sutter Institute for Medical Research, Sacramento, CA USA.Diagnostic Pathology Medical Group, Sacramento, CA USA.Sutter Medical Group, Sacramento, CA USA.Sutter Medical Group, Sacramento, CA USA.Diagnostic Pathology Medical Group, Sacramento, CA USA.Sutter Medical Group, Sacramento, CA USA.Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA ; Johns Hopkins University School of Medicine, Baltimore, MD USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27047724

Citation

Kim, Elizabeth Min Hui, et al. "Isolated Radial Scar Diagnosis By Core-needle Biopsy: Is Surgical Excision Necessary?" SpringerPlus, vol. 5, 2016, p. 398.
Kim EM, Hankins A, Cassity J, et al. Isolated radial scar diagnosis by core-needle biopsy: Is surgical excision necessary? Springerplus. 2016;5:398.
Kim, E. M., Hankins, A., Cassity, J., McDonald, D., White, B., Rowberry, R., Dutton, S., & Snyder, C. (2016). Isolated radial scar diagnosis by core-needle biopsy: Is surgical excision necessary? SpringerPlus, 5, 398. https://doi.org/10.1186/s40064-016-1993-z
Kim EM, et al. Isolated Radial Scar Diagnosis By Core-needle Biopsy: Is Surgical Excision Necessary. Springerplus. 2016;5:398. PubMed PMID: 27047724.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Isolated radial scar diagnosis by core-needle biopsy: Is surgical excision necessary? AU - Kim,Elizabeth Min Hui, AU - Hankins,Andrea, AU - Cassity,Jamie, AU - McDonald,Dennis, AU - White,Barbara, AU - Rowberry,Ron, AU - Dutton,Sharon, AU - Snyder,Claire, Y1 - 2016/03/31/ PY - 2016/03/08/received PY - 2016/03/10/accepted PY - 2016/4/6/entrez PY - 2016/4/6/pubmed PY - 2016/4/6/medline KW - Benign breast disease KW - Breast cancer KW - Radial scar KW - Radial sclerosis KW - Surgical management SP - 398 EP - 398 JF - SpringerPlus JO - Springerplus VL - 5 N2 - PURPOSE: Radial scar and radial sclerosis (RS) are considered benign breast lesions with proliferative features. There is sparse literature on frequency of cancer upgrade in these patients without atypical features found on image-guided needle biopsy. This study retrospectively reviews cases of isolated RS diagnosed on needle biopsy and evaluates the cancer upgrade after subsequent surgical excision. METHODS: We conducted a retrospective cross-sectional study of cases with an isolated RS diagnosis based on needle biopsy and subsequent surgical pathology among all patients between January 1, 2009 and December 31, 2013. Patients with concomitant atypia, lobular carcinoma in situ on core biopsy, complete excision of very small RS with needle biopsy, and radiology-pathology discordance were excluded. An upgrade from the needle biopsy of RS was defined as surgical excision pathology that revealed ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), and/or invasive lobular carcinoma (ILC). RESULTS: 10,921 image-guided needle biopsy pathology reports were collected and 88 patients (0.81 %) were identified as having isolated RS. Of these 88 patients, 63 (72 %) underwent excision. The upgrade rate to cancer on subsequent surgical excision was 1.59 % (1/63) for DCIS; 0 % (0/63) for IDC; and 0 % (0/63) ILC. Twenty-five patients who did not undergo surgical excision had stable imaging studies with mean (±SD) 26 (±20) months follow up. CONCLUSIONS: Isolated radial scar on needle biopsy may not warrant routine surgical excision given relatively low cancer upgrade rates. Advancement in breast imaging, pathology and multidisciplinary approaches to care may effectively guide non-surgical management of RS. SN - 2193-1801 UR - https://www.unboundmedicine.com/medline/citation/27047724/Isolated_radial_scar_diagnosis_by_core_needle_biopsy:_Is_surgical_excision_necessary L2 - https://dx.doi.org/10.1186/s40064-016-1993-z DB - PRIME DP - Unbound Medicine ER -
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