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Rethinking Routine Surgical Excision for all Radial Sclerosing Lesions of the Breast.
J Surg Res. 2022 Nov; 279:611-618.JS

Abstract

INTRODUCTION

The need for routine surgical excision of a radial sclerosing lesions (RSL) of the breast identified on percutaneous biopsy remains controversial, as contemporary upgrade rates are lower than historically cited.

MATERIALS AND METHODS

A prospectively-maintained database of high-risk breast biopsies undergoing multidisciplinary review at a single institution was queried to identify cases of RSL from 2/2015 to 11/2020. Demographic, radiologic, and pathologic variables were summarized using frequencies and analyzed in association with RSL excision status using mixed-effects logistic regression or Fisher's exact tests.

RESULTS

217 RSL were identified, diagnosed at a mean age of 57 y. The median imaging size was 1.3 cm and the majority had estimated >50% of the target removed by core needle biopsy. 32.3% underwent surgical excision of the RSL biopsy site and 2/70 (2.9%) upgraded to ductal carcinoma in situ (DCIS) on final surgical pathology. Upgrade was significantly higher for atypical RSL (P = 0.02). None of the RSL (n = 60) without atypia who had undergone excision were upgraded. For those omitting surgical excision, there was no subsequent breast cancer diagnosis at the RSL site over a mean follow-up of 23 mo.

CONCLUSIONS

Surgical excision may be omitted for RSL without atypia as this group has 0% risk of upgrade after multidisciplinary review.

Authors+Show Affiliations

University of Kansas Medical Center, Kansas City, Kansas.Division of Breast Imaging, Department of Radiology, The University of Kansas Health System, Kansas City, Kansas.Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas; The University of Kansas Cancer Center, Kansas City, Kansas.Division of Breast Surgical Oncology, Department of Surgery, The University of Kansas Health System, Kansas City, Kansas.Division of Breast Surgical Oncology, Department of Surgery, The University of Kansas Health System, Kansas City, Kansas.Division of Breast Surgical Oncology, Department of Surgery, The University of Kansas Health System, Kansas City, Kansas.Division of Breast Surgical Oncology, Department of Surgery, The University of Kansas Health System, Kansas City, Kansas. Electronic address: Amanda.Amin@UHhospitals.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

35926311

Citation

Patel, Meeli, et al. "Rethinking Routine Surgical Excision for All Radial Sclerosing Lesions of the Breast." The Journal of Surgical Research, vol. 279, 2022, pp. 611-618.
Patel M, Aripoli A, Chollet-Hinton L, et al. Rethinking Routine Surgical Excision for all Radial Sclerosing Lesions of the Breast. J Surg Res. 2022;279:611-618.
Patel, M., Aripoli, A., Chollet-Hinton, L., Larson, K. E., Balanoff, C. R., Kilgore, L. J., & Amin, A. L. (2022). Rethinking Routine Surgical Excision for all Radial Sclerosing Lesions of the Breast. The Journal of Surgical Research, 279, 611-618. https://doi.org/10.1016/j.jss.2022.06.048
Patel M, et al. Rethinking Routine Surgical Excision for All Radial Sclerosing Lesions of the Breast. J Surg Res. 2022;279:611-618. PubMed PMID: 35926311.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rethinking Routine Surgical Excision for all Radial Sclerosing Lesions of the Breast. AU - Patel,Meeli, AU - Aripoli,Allison, AU - Chollet-Hinton,Lynn, AU - Larson,Kelsey E, AU - Balanoff,Christa R, AU - Kilgore,Lyndsey J, AU - Amin,Amanda L, Y1 - 2022/08/01/ PY - 2021/12/23/received PY - 2022/06/10/revised PY - 2022/06/28/accepted PY - 2022/8/5/pubmed PY - 2022/8/5/medline PY - 2022/8/4/entrez KW - Atypia KW - Breast cancer KW - Ductal carcinoma in situ KW - Radial scar KW - Radial sclerosing lesion KW - Surgical de-escalation SP - 611 EP - 618 JF - The Journal of surgical research JO - J Surg Res VL - 279 N2 - INTRODUCTION: The need for routine surgical excision of a radial sclerosing lesions (RSL) of the breast identified on percutaneous biopsy remains controversial, as contemporary upgrade rates are lower than historically cited. MATERIALS AND METHODS: A prospectively-maintained database of high-risk breast biopsies undergoing multidisciplinary review at a single institution was queried to identify cases of RSL from 2/2015 to 11/2020. Demographic, radiologic, and pathologic variables were summarized using frequencies and analyzed in association with RSL excision status using mixed-effects logistic regression or Fisher's exact tests. RESULTS: 217 RSL were identified, diagnosed at a mean age of 57 y. The median imaging size was 1.3 cm and the majority had estimated >50% of the target removed by core needle biopsy. 32.3% underwent surgical excision of the RSL biopsy site and 2/70 (2.9%) upgraded to ductal carcinoma in situ (DCIS) on final surgical pathology. Upgrade was significantly higher for atypical RSL (P = 0.02). None of the RSL (n = 60) without atypia who had undergone excision were upgraded. For those omitting surgical excision, there was no subsequent breast cancer diagnosis at the RSL site over a mean follow-up of 23 mo. CONCLUSIONS: Surgical excision may be omitted for RSL without atypia as this group has 0% risk of upgrade after multidisciplinary review. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/35926311/Rethinking_Routine_Surgical_Excision_for_all_Radial_Sclerosing_Lesions_of_the_Breast_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(22)00412-7 DB - PRIME DP - Unbound Medicine ER -