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Radial scar on image-guided breast biopsy: is surgical excision necessary?
Breast Cancer Res Treat. 2018 Jul; 170(2):313-320.BC

Abstract

PURPOSE

Radial scar's stellate appearance may mimic carcinoma mammographically and histologically. Management of radial scar (RS) found on breast core needle biopsies (CNB) ranges from excision to clinical observation due to the variation in reported upgrades to malignancy at surgical excision. We examined the upgrade rate in patients with RS detected on CNB at our institution and reviewed the current literature.

METHODS

A retrospective study was conducted of all cases with RS diagnosed on CNB between December 2006 and March 2017 at our institution. Inclusion criteria were patients with "pure" RS and RS associated with high-risk lesions (HRL). Upgrade was defined as invasive or non-invasive cancer in the excisional biopsy.

RESULTS

157 cases were identified with RS on CNB, and 122 cases met inclusion criteria. Of these 122 cases, 91 (75%) had pure RS on CNB while 31 (25%) had associated atypia or HRL. 81 (66%) of patients proceeded to excisional biopsy and 41 (34%) did not. Two patients (1.6% of total) were found to have a low-grade invasive ductal carcinoma (0.6 and 0.8 cm) upon surgical excision. None of the remaining 120 patients developed an ipsilateral breast cancer with a mean of 32.3-month follow-up.

CONCLUSIONS

We found a very low upgrade rate to breast cancer when RS was found on CNB with or without associated HRL. Our results are consistent with other reported series. Our data do not support surgical excision for RS but rather close clinical follow-up for patients with RS on CNB.

Authors+Show Affiliations

Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO, 63110, USA. w.chou@wustl.edu.Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA. John Cochran Veterans Administration Hospital, St. Louis, MO, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29532340

Citation

Chou, Wendy Yen Yun, et al. "Radial Scar On Image-guided Breast Biopsy: Is Surgical Excision Necessary?" Breast Cancer Research and Treatment, vol. 170, no. 2, 2018, pp. 313-320.
Chou WYY, Veis DJ, Aft R. Radial scar on image-guided breast biopsy: is surgical excision necessary? Breast Cancer Res Treat. 2018;170(2):313-320.
Chou, W. Y. Y., Veis, D. J., & Aft, R. (2018). Radial scar on image-guided breast biopsy: is surgical excision necessary? Breast Cancer Research and Treatment, 170(2), 313-320. https://doi.org/10.1007/s10549-018-4741-y
Chou WYY, Veis DJ, Aft R. Radial Scar On Image-guided Breast Biopsy: Is Surgical Excision Necessary. Breast Cancer Res Treat. 2018;170(2):313-320. PubMed PMID: 29532340.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radial scar on image-guided breast biopsy: is surgical excision necessary? AU - Chou,Wendy Yen Yun, AU - Veis,Deborah J, AU - Aft,Rebecca, Y1 - 2018/03/12/ PY - 2018/02/26/received PY - 2018/03/01/accepted PY - 2018/3/14/pubmed PY - 2019/3/7/medline PY - 2018/3/14/entrez KW - Breast cancer KW - Core needle biopsy KW - Radial scar SP - 313 EP - 320 JF - Breast cancer research and treatment JO - Breast Cancer Res Treat VL - 170 IS - 2 N2 - PURPOSE: Radial scar's stellate appearance may mimic carcinoma mammographically and histologically. Management of radial scar (RS) found on breast core needle biopsies (CNB) ranges from excision to clinical observation due to the variation in reported upgrades to malignancy at surgical excision. We examined the upgrade rate in patients with RS detected on CNB at our institution and reviewed the current literature. METHODS: A retrospective study was conducted of all cases with RS diagnosed on CNB between December 2006 and March 2017 at our institution. Inclusion criteria were patients with "pure" RS and RS associated with high-risk lesions (HRL). Upgrade was defined as invasive or non-invasive cancer in the excisional biopsy. RESULTS: 157 cases were identified with RS on CNB, and 122 cases met inclusion criteria. Of these 122 cases, 91 (75%) had pure RS on CNB while 31 (25%) had associated atypia or HRL. 81 (66%) of patients proceeded to excisional biopsy and 41 (34%) did not. Two patients (1.6% of total) were found to have a low-grade invasive ductal carcinoma (0.6 and 0.8 cm) upon surgical excision. None of the remaining 120 patients developed an ipsilateral breast cancer with a mean of 32.3-month follow-up. CONCLUSIONS: We found a very low upgrade rate to breast cancer when RS was found on CNB with or without associated HRL. Our results are consistent with other reported series. Our data do not support surgical excision for RS but rather close clinical follow-up for patients with RS on CNB. SN - 1573-7217 UR - https://www.unboundmedicine.com/medline/citation/29532340/Radial_scar_on_image_guided_breast_biopsy:_is_surgical_excision_necessary L2 - https://doi.org/10.1007/s10549-018-4741-y DB - PRIME DP - Unbound Medicine ER -