David Pinkney MD, Presenter: Nothing to Disclose

Feras Mossa-Basha MD, Abstract Co-Author: Nothing to Disclose

Sabala Mandava MD, Abstract Co-Author: Nothing to Disclose

Although inherently benign, radial scars (RS) and complex sclerosing lesions (CSL) diagnosed on core needle biopsy (CNB) are considered “high risk breast lesions” and surgical excision (SE) is routinely recommended to rule out an associated occult malignancy. However, this practice is controversial and is seen by many as unwarranted, especially with the improving ability to accurately discern lesions associated with premalignant atypical epithelial proliferation from those without. We performed a retrospective review to evaluate core needle biopsy diagnosed RS/CSL with and without associated atypia and the subsequent upgrade rate to malignancy on surgical excisional biopsy.  

The records of all CNB performed at our institution between 9/2009 and 2/2014 were analyzed. 112 patients were diagnosed with RS/CSL by CNB during this time. Patients were excluded who did not have definitive SE pathology reports at our institution or had a synchronous/prior diagnosis of breast cancer. 63 patients remained and the CNB pathology results were compared to SE biopsy results to assess the upgrade rate to malignancy.

15 of the 63 patients diagnosed with RS/CSL had associated atypia on CNB. None of the 48 patients without atypia were upgraded to malignancy at SE for a malignancy underestimation rate of 0%. If the patients with RS/CSL lesions without atypia were simply followed, 48 of the 63 patients (76.2%) would have avoided what we see as unnecessary surgery.

In our series, 0 of the 48 patients diagnosed on CNB with RS/CSL without atypia had associated malignancy on SE. Our results are in disagreement with several older studies that suggest a small (<10%) upgrade rate, perhaps at least in part due to improving sampling and histologic techniques. A large-scale prospective study is needed to confirm the true risk of RS/CSL without atypia. Regardless, women should be well informed of the low or absent risk of associated malignancy. 

There is growing concern among patients and physicians regarding false positive diagnoses in mammography. Our intent is to incite change in the management of radial scars/complex sclerosing lesions.

Pinkney, D, Mossa-Basha, F, Mandava, S, Should Radial Scars Diagnosed on Core Needle Biopsy Continue to be Surgically Excised? A Single Center Retrospective Review of the Incidence of Associated Malignancy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003347.html