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Outcome of radial scar/complex sclerosing lesion associated with epithelial proliferations with atypia diagnosed on breast core biopsy: results from a multicentric UK-based study.
J Clin Pathol. 2019 Dec; 72(12):800-804.JC

Abstract

AIMS

The clinical significance of radial scar (RS)/complex sclerosing lesion (CSL) with high-risk lesions (epithelial atypia) diagnosed on needle core biopsy is not well defined. We aimed at assessing the upgrade rate to ductal carcinoma in situ (DCIS) and invasive carcinoma on the surgical excision specimen in a large cohort with RS/CSL associated with atypia.

METHODS

157 women with a needle core biopsy diagnosis of a RS/CSL with atypia and follow-up histology were studied. Histological findings, including different forms of the atypical lesions and final histological outcome in the excision specimens, were retrieved and analysed, and the upgrade rates for malignancy and for invasive carcinoma were calculated.

RESULTS

69.43% of the cases were associated with atypical ductal hyperplasia (ADH) or atypia not otherwise classifiable, whereas lobular neoplasia was seen in 21.66%. On final histology, 39 cases were malignant (overall upgrade rate of 24.84%); 12 were invasive and 27 had DCIS. The upgrade differed according to the type of atypia and was highest for ADH (35%). When associated with lobular neoplasia, the upgrade rate was 11.76%. The upgrade rate's variability was also considerably lower when considering the upgrade to invasive carcinoma alone for any associated lesion.

CONCLUSIONS

The upgrade rate for ADH diagnosed on needle core biopsy with RS is similar to that of ADH without RS and therefore should be managed similarly. RS associated with lobular neoplasia is less frequently associated with malignant outcome. Most lesions exhibiting some degree of atypia showed a similar upgrade rate to invasive carcinoma. Management of RS should be based on the concurrent atypical lesion.

Authors+Show Affiliations

Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK Emad.Rakha@nuh.nhs.uk. Faculty of Medicine, Menoufiya University, Al Minufya, Egypt.Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.Specialization School in Anatomic Pathology, University of Pavia, Pavia, Italy.Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK.Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK.Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK.Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK.South Birmingham Breast Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK.Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK.Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK. Faculty of Medicine, Menoufiya University, Al Minufya, Egypt.Faculty of Medicine, Menoufiya University, Al Minufya, Egypt.Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK.Department of Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

31350292

Citation

Rakha, Emad, et al. "Outcome of Radial Scar/complex Sclerosing Lesion Associated With Epithelial Proliferations With Atypia Diagnosed On Breast Core Biopsy: Results From a Multicentric UK-based Study." Journal of Clinical Pathology, vol. 72, no. 12, 2019, pp. 800-804.
Rakha E, Beca F, D'Andrea M, et al. Outcome of radial scar/complex sclerosing lesion associated with epithelial proliferations with atypia diagnosed on breast core biopsy: results from a multicentric UK-based study. J Clin Pathol. 2019;72(12):800-804.
Rakha, E., Beca, F., D'Andrea, M., Abbas, A., Petrou-Nunn, W., Shaaban, A. M., Kandiyil, A., Smith, S., Menon, S., Elsheikh, S., ElSayed, M. E., Lee, A. H., & Sharma, N. (2019). Outcome of radial scar/complex sclerosing lesion associated with epithelial proliferations with atypia diagnosed on breast core biopsy: results from a multicentric UK-based study. Journal of Clinical Pathology, 72(12), 800-804. https://doi.org/10.1136/jclinpath-2019-205764
Rakha E, et al. Outcome of Radial Scar/complex Sclerosing Lesion Associated With Epithelial Proliferations With Atypia Diagnosed On Breast Core Biopsy: Results From a Multicentric UK-based Study. J Clin Pathol. 2019;72(12):800-804. PubMed PMID: 31350292.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome of radial scar/complex sclerosing lesion associated with epithelial proliferations with atypia diagnosed on breast core biopsy: results from a multicentric UK-based study. AU - Rakha,Emad, AU - Beca,Francisco, AU - D'Andrea,Mariangela, AU - Abbas,Areeg, AU - Petrou-Nunn,William, AU - Shaaban,Abeer M, AU - Kandiyil,Aneeshya, AU - Smith,Samantha, AU - Menon,Sindhu, AU - Elsheikh,Somaia, AU - ElSayed,Maysa E, AU - Lee,Andrew Hs, AU - Sharma,Nisha, Y1 - 2019/07/26/ PY - 2019/02/04/received PY - 2019/05/13/revised PY - 2019/06/10/accepted PY - 2019/7/28/pubmed PY - 2019/12/4/medline PY - 2019/7/28/entrez KW - B3 KW - atypia KW - breast core biopsy KW - outcome KW - radial scar SP - 800 EP - 804 JF - Journal of clinical pathology JO - J Clin Pathol VL - 72 IS - 12 N2 - AIMS: The clinical significance of radial scar (RS)/complex sclerosing lesion (CSL) with high-risk lesions (epithelial atypia) diagnosed on needle core biopsy is not well defined. We aimed at assessing the upgrade rate to ductal carcinoma in situ (DCIS) and invasive carcinoma on the surgical excision specimen in a large cohort with RS/CSL associated with atypia. METHODS: 157 women with a needle core biopsy diagnosis of a RS/CSL with atypia and follow-up histology were studied. Histological findings, including different forms of the atypical lesions and final histological outcome in the excision specimens, were retrieved and analysed, and the upgrade rates for malignancy and for invasive carcinoma were calculated. RESULTS: 69.43% of the cases were associated with atypical ductal hyperplasia (ADH) or atypia not otherwise classifiable, whereas lobular neoplasia was seen in 21.66%. On final histology, 39 cases were malignant (overall upgrade rate of 24.84%); 12 were invasive and 27 had DCIS. The upgrade differed according to the type of atypia and was highest for ADH (35%). When associated with lobular neoplasia, the upgrade rate was 11.76%. The upgrade rate's variability was also considerably lower when considering the upgrade to invasive carcinoma alone for any associated lesion. CONCLUSIONS: The upgrade rate for ADH diagnosed on needle core biopsy with RS is similar to that of ADH without RS and therefore should be managed similarly. RS associated with lobular neoplasia is less frequently associated with malignant outcome. Most lesions exhibiting some degree of atypia showed a similar upgrade rate to invasive carcinoma. Management of RS should be based on the concurrent atypical lesion. SN - 1472-4146 UR - https://www.unboundmedicine.com/medline/citation/31350292/Outcome_of_radial_scar/complex_sclerosing_lesion_associated_with_epithelial_proliferations_with_atypia_diagnosed_on_breast_core_biopsy:_results_from_a_multicentric_UK_based_study_ DB - PRIME DP - Unbound Medicine ER -