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Radial scars diagnosed on breast core biopsy: Frequency of atypia and carcinoma on excision and implications for management.
Breast. 2016 Dec; 30:201-207.B

Abstract

AIMS

The risk of finding carcinoma in excisions following a core needle biopsy diagnosis of radial scar is not well defined and clinical management is variable. The aim of this study is to determine the frequency of high-risk lesions, ductal carcinoma in situ, and invasive carcinoma in excisions following a core biopsy diagnosis of radial scar.

METHODS AND RESULTS

Dedicated breast pathologists and radiologists correlated the histologic and radiologic findings and categorized radial scars as the target lesion or an incidental finding. High-risk lesions were defined as atypical hyperplasia or classical lobular carcinoma in situ. Of the 79 radial scars identified over a 14-year period, 22 were associated with atypia or carcinoma in the core biopsy. Thirty-seven (37) of the 57 benign radial scars underwent excision with benign findings in 30 (81%), high-risk lesions in six (16%), and flat epithelial atypia in one (3%). There were no upgrades to carcinoma. One patient with a benign radial scar developed a 3-mm focus of intermediate-grade estrogen receptor-positive ductal carcinoma in situ in the same quadrant of the ipsilateral breast 72 months after excision. One patient with an incidental un-excised benign radial scar was diagnosed with ductal carcinoma in situ at a separate site of suspicious calcifications.

CONCLUSIONS

In this series, none of the benign radial scars was upgraded to carcinoma. Radial scar was the targeted lesion in all cases with high-risk lesions on excision. Surgical excision may not be mandatory for patients with benign incidental radial scars on core biopsy.

Authors+Show Affiliations

Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA. Electronic address: donalda@ccf.org.Imaging Institute, Department of Breast Imaging, Cleveland Clinic, Cleveland, OH, USA. Electronic address: sieckl@ccf.org.Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA. Electronic address: boothc1@ccf.org.Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA. Electronic address: calhoub@ccf.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27371970

Citation

Donaldson, Alana R., et al. "Radial Scars Diagnosed On Breast Core Biopsy: Frequency of Atypia and Carcinoma On Excision and Implications for Management." Breast (Edinburgh, Scotland), vol. 30, 2016, pp. 201-207.
Donaldson AR, Sieck L, Booth CN, et al. Radial scars diagnosed on breast core biopsy: Frequency of atypia and carcinoma on excision and implications for management. Breast. 2016;30:201-207.
Donaldson, A. R., Sieck, L., Booth, C. N., & Calhoun, B. C. (2016). Radial scars diagnosed on breast core biopsy: Frequency of atypia and carcinoma on excision and implications for management. Breast (Edinburgh, Scotland), 30, 201-207. https://doi.org/10.1016/j.breast.2016.06.007
Donaldson AR, et al. Radial Scars Diagnosed On Breast Core Biopsy: Frequency of Atypia and Carcinoma On Excision and Implications for Management. Breast. 2016;30:201-207. PubMed PMID: 27371970.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radial scars diagnosed on breast core biopsy: Frequency of atypia and carcinoma on excision and implications for management. AU - Donaldson,Alana R, AU - Sieck,Leah, AU - Booth,Christine N, AU - Calhoun,Benjamin C, Y1 - 2016/06/29/ PY - 2016/03/22/received PY - 2016/06/03/revised PY - 2016/06/04/accepted PY - 2016/7/4/pubmed PY - 2017/3/14/medline PY - 2016/7/4/entrez KW - Breast KW - Core biopsy KW - Diagnosis KW - Pathology KW - Radial scar KW - Screening SP - 201 EP - 207 JF - Breast (Edinburgh, Scotland) JO - Breast VL - 30 N2 - AIMS: The risk of finding carcinoma in excisions following a core needle biopsy diagnosis of radial scar is not well defined and clinical management is variable. The aim of this study is to determine the frequency of high-risk lesions, ductal carcinoma in situ, and invasive carcinoma in excisions following a core biopsy diagnosis of radial scar. METHODS AND RESULTS: Dedicated breast pathologists and radiologists correlated the histologic and radiologic findings and categorized radial scars as the target lesion or an incidental finding. High-risk lesions were defined as atypical hyperplasia or classical lobular carcinoma in situ. Of the 79 radial scars identified over a 14-year period, 22 were associated with atypia or carcinoma in the core biopsy. Thirty-seven (37) of the 57 benign radial scars underwent excision with benign findings in 30 (81%), high-risk lesions in six (16%), and flat epithelial atypia in one (3%). There were no upgrades to carcinoma. One patient with a benign radial scar developed a 3-mm focus of intermediate-grade estrogen receptor-positive ductal carcinoma in situ in the same quadrant of the ipsilateral breast 72 months after excision. One patient with an incidental un-excised benign radial scar was diagnosed with ductal carcinoma in situ at a separate site of suspicious calcifications. CONCLUSIONS: In this series, none of the benign radial scars was upgraded to carcinoma. Radial scar was the targeted lesion in all cases with high-risk lesions on excision. Surgical excision may not be mandatory for patients with benign incidental radial scars on core biopsy. SN - 1532-3080 UR - https://www.unboundmedicine.com/medline/citation/27371970/Radial_scars_diagnosed_on_breast_core_biopsy:_Frequency_of_atypia_and_carcinoma_on_excision_and_implications_for_management_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0960-9776(16)30081-9 DB - PRIME DP - Unbound Medicine ER -