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Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: Low risk of carcinoma on excision in cases with clinical and imaging concordance.
Breast J. 2018 03; 24(2):133-138.BJ

Abstract

Complex or radial sclerosing lesions (CSL/RSL) are uncommon diagnoses on core needle biopsy with a reported upgrade rate ranging between 0% and 23%. As a result, their management remains controversial. In this study, we sought to determine the rate of malignancy on excision for patients with pure CSL/RSL on core biopsy, and to evaluate future breast cancer risk when CSL/RSL is managed without excision. We retrospectively reviewed 118 cases of CSL/RSL diagnosed on image-guided breast biopsies between 2005 and 2014 at our institution. Of 98 analyzed patients, 34 (35%) underwent excision and 64 (65%) were observed. Demographic and clinical variables between excision and observation groups were compared. In excised specimens, factors associated with upgrade to malignancy were evaluated. The median age at diagnosis was 49 years (range, 27-88 years). In the excision group, 3/34 cases were associated with malignancy, an overall upgrade rate of 9%. All malignant cases had core needle biopsies interpreted as discordant and were BIRADS 4B or more on imaging. In the observation group, at a median follow-up of 2.2 years, 3/64 (5%) patients developed ipsilateral cancers, all of which were distant from the index CSL/RSL. In our series, we report a 9% malignancy rate on excision of BIRADS >4C lesions characterized as CSL/RSL on core biopsy. In patients with concordant biopsies and BIRADS 4A or lower lesions who underwent observation, we found a low rate of subsequent ipsilateral cancers. Further studies are needed to confirm that for CSL/RSL in concordant core biopsies and BIRADS 4A or lower, nonpalpable lesions, observation may be a reasonable alternative to excision.

Authors+Show Affiliations

Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28685897

Citation

Nakhlis, Faina, et al. "Complex Sclerosing Lesions and Radial Sclerosing Lesions On Core Needle Biopsy: Low Risk of Carcinoma On Excision in Cases With Clinical and Imaging Concordance." The Breast Journal, vol. 24, no. 2, 2018, pp. 133-138.
Nakhlis F, Lester S, Denison C, et al. Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: Low risk of carcinoma on excision in cases with clinical and imaging concordance. Breast J. 2018;24(2):133-138.
Nakhlis, F., Lester, S., Denison, C., Wong, S. M., Mongiu, A., & Golshan, M. (2018). Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: Low risk of carcinoma on excision in cases with clinical and imaging concordance. The Breast Journal, 24(2), 133-138. https://doi.org/10.1111/tbj.12859
Nakhlis F, et al. Complex Sclerosing Lesions and Radial Sclerosing Lesions On Core Needle Biopsy: Low Risk of Carcinoma On Excision in Cases With Clinical and Imaging Concordance. Breast J. 2018;24(2):133-138. PubMed PMID: 28685897.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: Low risk of carcinoma on excision in cases with clinical and imaging concordance. AU - Nakhlis,Faina, AU - Lester,Susan, AU - Denison,Christine, AU - Wong,Stephanie M, AU - Mongiu,Anne, AU - Golshan,Mehra, Y1 - 2017/07/07/ PY - 2016/07/22/received PY - 2016/12/01/revised PY - 2016/12/01/accepted PY - 2017/7/8/pubmed PY - 2019/3/8/medline PY - 2017/7/8/entrez KW - biopsy KW - breast neoplasms KW - complex sclerosing lesions KW - excisional biopsy KW - fine-needle KW - radial scar KW - radial sclerosing lesions SP - 133 EP - 138 JF - The breast journal JO - Breast J VL - 24 IS - 2 N2 - Complex or radial sclerosing lesions (CSL/RSL) are uncommon diagnoses on core needle biopsy with a reported upgrade rate ranging between 0% and 23%. As a result, their management remains controversial. In this study, we sought to determine the rate of malignancy on excision for patients with pure CSL/RSL on core biopsy, and to evaluate future breast cancer risk when CSL/RSL is managed without excision. We retrospectively reviewed 118 cases of CSL/RSL diagnosed on image-guided breast biopsies between 2005 and 2014 at our institution. Of 98 analyzed patients, 34 (35%) underwent excision and 64 (65%) were observed. Demographic and clinical variables between excision and observation groups were compared. In excised specimens, factors associated with upgrade to malignancy were evaluated. The median age at diagnosis was 49 years (range, 27-88 years). In the excision group, 3/34 cases were associated with malignancy, an overall upgrade rate of 9%. All malignant cases had core needle biopsies interpreted as discordant and were BIRADS 4B or more on imaging. In the observation group, at a median follow-up of 2.2 years, 3/64 (5%) patients developed ipsilateral cancers, all of which were distant from the index CSL/RSL. In our series, we report a 9% malignancy rate on excision of BIRADS >4C lesions characterized as CSL/RSL on core biopsy. In patients with concordant biopsies and BIRADS 4A or lower lesions who underwent observation, we found a low rate of subsequent ipsilateral cancers. Further studies are needed to confirm that for CSL/RSL in concordant core biopsies and BIRADS 4A or lower, nonpalpable lesions, observation may be a reasonable alternative to excision. SN - 1524-4741 UR - https://www.unboundmedicine.com/medline/citation/28685897/Complex_sclerosing_lesions_and_radial_sclerosing_lesions_on_core_needle_biopsy:_Low_risk_of_carcinoma_on_excision_in_cases_with_clinical_and_imaging_concordance_ DB - PRIME DP - Unbound Medicine ER -