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Reducing indications for radial scar surgical excision in Slovenian breast cancer screening program.
Ann Diagn Pathol. 2020 Apr; 45:151438.AD

Abstract

PURPOSE

Management of the radial scar (RS)/complex sclerosing lesion (CSL) diagnosed by core needle biopsy (CNB) in breast cancer screening population (BCSP) is controversial due to its intrinsic malignant potential. We aimed to determine (i) the rate of upgrade of the RS/CSL to malignant lesions and (ii) radiological characteristics and CNB histopathological findings of the lesions related to the upgrade of the RS/CSL to malignant lesions after surgical excision in our BCSP.

PATIENTS AND METHODS

Database of Slovenian National Breast Cancer Screening Program was checked for terms RS/CSL in all patients who underwent CNB in the period 2008-2018. The ratios of upgrade from CNB RS/SCL to malignant lesions after surgical excision were calculated with specific interest to the radiological characteristics and the CNB patohistologically findings of the lesions.

RESULTS

Of 162 patients with diagnosis of RS/CSL on the CNB, 121/156 (78%) cases underwent surgical excision. 6 of 121 (5%) cases were upgraded to a malignant diagnosis in surgical specimen, 3 cases of invasive carcinoma and 3 cases of DCIS, respectively. Five of the upgraded cases (5/6, 83.3%) showed atypical epithelial proliferative lesions (AEPL) on CNB. In one upgraded case without AEPL the lesion presented as 33 mm architectural distortion with microcalcifications on the mammogram.

CONCLUSIONS

In BCSP setting RS/CSL without AEPL/papilloma and those measuring less than 2 cm in the largest diameter can be followed radiologically. Increasing the number of cores and adequate sampling of the periphery and the centre of the RS/CSL improves the pick-up rate of associated atypia/malignancy.

Authors+Show Affiliations

Institute of Oncology Ljubljana, Slovenia. Electronic address: ggasljevic@onko-i.si.Institute of Oncology Ljubljana, Slovenia. Electronic address: khertl@onko-i.si.Institute of Oncology Ljubljana, Slovenia. Electronic address: bgazic@onko-i.si.Institute of Oncology Ljubljana, Slovenia. Electronic address: jlamovec@onko-i.si.Institute of Oncology Ljubljana, Slovenia. Electronic address: jzgajnar@onko-i.si.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31927469

Citation

Gašljević, Gorana, et al. "Reducing Indications for Radial Scar Surgical Excision in Slovenian Breast Cancer Screening Program." Annals of Diagnostic Pathology, vol. 45, 2020, p. 151438.
Gašljević G, Hertl K, Gazić B, et al. Reducing indications for radial scar surgical excision in Slovenian breast cancer screening program. Ann Diagn Pathol. 2020;45:151438.
Gašljević, G., Hertl, K., Gazić, B., Lamovec, J., & Žgajnar, J. (2020). Reducing indications for radial scar surgical excision in Slovenian breast cancer screening program. Annals of Diagnostic Pathology, 45, 151438. https://doi.org/10.1016/j.anndiagpath.2019.151438
Gašljević G, et al. Reducing Indications for Radial Scar Surgical Excision in Slovenian Breast Cancer Screening Program. Ann Diagn Pathol. 2020;45:151438. PubMed PMID: 31927469.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reducing indications for radial scar surgical excision in Slovenian breast cancer screening program. AU - Gašljević,Gorana, AU - Hertl,Kristjana, AU - Gazić,Barbara, AU - Lamovec,Janez, AU - Žgajnar,Janez, Y1 - 2019/12/13/ PY - 2019/11/21/received PY - 2019/12/05/accepted PY - 2020/1/14/pubmed PY - 2021/1/7/medline PY - 2020/1/14/entrez KW - Breast KW - Complex sclerosing lesion KW - Mammography screening KW - Radial scar KW - Surgery SP - 151438 EP - 151438 JF - Annals of diagnostic pathology JO - Ann Diagn Pathol VL - 45 N2 - PURPOSE: Management of the radial scar (RS)/complex sclerosing lesion (CSL) diagnosed by core needle biopsy (CNB) in breast cancer screening population (BCSP) is controversial due to its intrinsic malignant potential. We aimed to determine (i) the rate of upgrade of the RS/CSL to malignant lesions and (ii) radiological characteristics and CNB histopathological findings of the lesions related to the upgrade of the RS/CSL to malignant lesions after surgical excision in our BCSP. PATIENTS AND METHODS: Database of Slovenian National Breast Cancer Screening Program was checked for terms RS/CSL in all patients who underwent CNB in the period 2008-2018. The ratios of upgrade from CNB RS/SCL to malignant lesions after surgical excision were calculated with specific interest to the radiological characteristics and the CNB patohistologically findings of the lesions. RESULTS: Of 162 patients with diagnosis of RS/CSL on the CNB, 121/156 (78%) cases underwent surgical excision. 6 of 121 (5%) cases were upgraded to a malignant diagnosis in surgical specimen, 3 cases of invasive carcinoma and 3 cases of DCIS, respectively. Five of the upgraded cases (5/6, 83.3%) showed atypical epithelial proliferative lesions (AEPL) on CNB. In one upgraded case without AEPL the lesion presented as 33 mm architectural distortion with microcalcifications on the mammogram. CONCLUSIONS: In BCSP setting RS/CSL without AEPL/papilloma and those measuring less than 2 cm in the largest diameter can be followed radiologically. Increasing the number of cores and adequate sampling of the periphery and the centre of the RS/CSL improves the pick-up rate of associated atypia/malignancy. SN - 1532-8198 UR - https://www.unboundmedicine.com/medline/citation/31927469/Reducing_indications_for_radial_scar_surgical_excision_in_Slovenian_breast_cancer_screening_program_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1092-9134(19)30367-3 DB - PRIME DP - Unbound Medicine ER -