Tags

Type your tag names separated by a space and hit enter

Management of radial scars/complex sclerosing lesions of the breast diagnosed on vacuum-assisted large-core biopsy: is surgery always necessary?
Histopathology. 2019 Dec; 75(6):900-915.H

Abstract

AIMS

The diagnosis of radial scars/complex sclerosing lesions (RSs/CSLs) onpercutaneous biopsy carries a risk of histological underestimation. Consequently, surgical excision is often performed in order to exclude a possible associated malignancy. The aim of this study was to assess the rate of 'upgrade to carcinoma' upon subsequent surgical excision of RS/CSL cases diagnosed on vacuum-assisted large-core biopsy (VALCB). We also analysed the risk factors for upgrade in order to determine a subset of patients who could avoid surgery and benefit from conservative management with clinical and imaging follow-up.

METHODS AND RESULTS

This was a retrospective observational single-centre study on 174 consecutive RS/CSL cases diagnosed on VALCB from May 2008 to October 2015. Univariate analysis was performed to identify clinical, radiological and histological risk factors for upgrade. Surgical excision was performed following VALCB diagnosis of 88 RS/CSL cases with or without associated atypia. The overall rate of surgical upgrade to carcinoma was 9.1% (8/88). None of the benign biopsies without atypia was surgically upgraded. Additional to atypia, risk factors for upgrade were non-incidental finding of the RS/CSL, the mammographic appearance, and the number of fragments obtained during the biopsy procedure (P < 0.05).

CONCLUSION

We demonstrate that VALCB revealing an RS/CSL is reliable for excluding malignancy when there is no associated atypia and when radiological and histological findings are concordant. In such cases, surgery can be avoided in favour of clinical and imaging follow-up. When an RS/CSL is associated with atypia, the decision to perform surgical excision depends on other associated risk factors.

Authors+Show Affiliations

Medical Imaging Department, Institut Bergonié, Bordeaux, France.Department of Biopathology, Institut Bergonié, Bordeaux, France.Department of Biopathology, Institut Bergonié, Bordeaux, France.Medical Imaging Department, Institut Bergonié, Bordeaux, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31286532

Citation

Bacci, Julia, et al. "Management of Radial Scars/complex Sclerosing Lesions of the Breast Diagnosed On Vacuum-assisted Large-core Biopsy: Is Surgery Always Necessary?" Histopathology, vol. 75, no. 6, 2019, pp. 900-915.
Bacci J, MacGrogan G, Alran L, et al. Management of radial scars/complex sclerosing lesions of the breast diagnosed on vacuum-assisted large-core biopsy: is surgery always necessary? Histopathology. 2019;75(6):900-915.
Bacci, J., MacGrogan, G., Alran, L., & Labrot-Hurtevent, G. (2019). Management of radial scars/complex sclerosing lesions of the breast diagnosed on vacuum-assisted large-core biopsy: is surgery always necessary? Histopathology, 75(6), 900-915. https://doi.org/10.1111/his.13950
Bacci J, et al. Management of Radial Scars/complex Sclerosing Lesions of the Breast Diagnosed On Vacuum-assisted Large-core Biopsy: Is Surgery Always Necessary. Histopathology. 2019;75(6):900-915. PubMed PMID: 31286532.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of radial scars/complex sclerosing lesions of the breast diagnosed on vacuum-assisted large-core biopsy: is surgery always necessary? AU - Bacci,Julia, AU - MacGrogan,Gaëtan, AU - Alran,Léonie, AU - Labrot-Hurtevent,Gabrielle, Y1 - 2019/10/18/ PY - 2019/05/05/received PY - 2019/06/10/revised PY - 2019/07/04/accepted PY - 2019/7/10/pubmed PY - 2020/4/28/medline PY - 2019/7/10/entrez KW - atypia KW - complex sclerosing lesion KW - radial scar KW - surgical excision KW - vacuum-assisted large-core biopsy SP - 900 EP - 915 JF - Histopathology JO - Histopathology VL - 75 IS - 6 N2 - AIMS: The diagnosis of radial scars/complex sclerosing lesions (RSs/CSLs) onpercutaneous biopsy carries a risk of histological underestimation. Consequently, surgical excision is often performed in order to exclude a possible associated malignancy. The aim of this study was to assess the rate of 'upgrade to carcinoma' upon subsequent surgical excision of RS/CSL cases diagnosed on vacuum-assisted large-core biopsy (VALCB). We also analysed the risk factors for upgrade in order to determine a subset of patients who could avoid surgery and benefit from conservative management with clinical and imaging follow-up. METHODS AND RESULTS: This was a retrospective observational single-centre study on 174 consecutive RS/CSL cases diagnosed on VALCB from May 2008 to October 2015. Univariate analysis was performed to identify clinical, radiological and histological risk factors for upgrade. Surgical excision was performed following VALCB diagnosis of 88 RS/CSL cases with or without associated atypia. The overall rate of surgical upgrade to carcinoma was 9.1% (8/88). None of the benign biopsies without atypia was surgically upgraded. Additional to atypia, risk factors for upgrade were non-incidental finding of the RS/CSL, the mammographic appearance, and the number of fragments obtained during the biopsy procedure (P < 0.05). CONCLUSION: We demonstrate that VALCB revealing an RS/CSL is reliable for excluding malignancy when there is no associated atypia and when radiological and histological findings are concordant. In such cases, surgery can be avoided in favour of clinical and imaging follow-up. When an RS/CSL is associated with atypia, the decision to perform surgical excision depends on other associated risk factors. SN - 1365-2559 UR - https://www.unboundmedicine.com/medline/citation/31286532/Management_of_radial_scars/complex_sclerosing_lesions_of_the_breast_diagnosed_on_vacuum_assisted_large_core_biopsy:_is_surgery_always_necessary DB - PRIME DP - Unbound Medicine ER -