Elizabeth Kalife MD, Abstract Co-Author: Nothing to Disclose

Ana P. Lourenco MD, Presenter: Nothing to Disclose

Murray Resnick MD, Abstract Co-Author: Nothing to Disclose

Martha Beretta Mainiero MD, Abstract Co-Author: Nothing to Disclose

Yihong Wang MD, Abstract Co-Author: Nothing to Disclose

To review malignancy rates of radial scars/ radial sclerosing lesions without atypia (RSL) detected on core needle biopsy.

An IRB approved, HIPAA compliant retrospective review of the pathology database from 1/2003 thru 7/2013 was conducted to identify all needle biopsies with diagnosis of RSL without atypia. Any cases associated with atypia (ductal, lobular, flat epithelial, columnar cell) or malignancy were excluded. Biopsy and excision specimens were reviewed by a breast pathologist and imaging follow-up was reviewed by a breast radiologist. Patient demographics, lesion size, all available excisional pathology and imaging follow-up were reviewed using the electronic medical record and results recorded in a database. Cases were categorized as incidental if the biopsy was for calcifications and targeted if the biopsy was for mass, architectural distortion or MRI enhancement.

100 cases were identified, 54 incidental and 46 targeted. Average patient age was 57 (incidental) and 52 (targeted), (p=.018). Average pathologic size was smaller for the incidental group (3mm) than for the targeted group (6mm), p<.001. Of the 54 incidental lesions, 14 had surgical excision, 30 had imaging follow-up and 10 were lost to follow-up. Of the 46 targeted lesions, 27 had excision, 11 had imaging follow-up and 8 were lost to follow-up. Of the 41 surgical excisions, 4 (10%) (3 incidental, 1 targeted) identified atypia; none were up-graded to malignancy. All 4 have negative imaging follow-up (range 1-7 years). There were no ipsilateral malignancies among the 41 patients with imaging follow-up (mean follow-up 4 years). One of the 30 patients with imaging follow-up after an incidental RSL biopsy developed a contralateral invasive ductal carcinoma 7 years after biopsy.

In this study, there were no associated ipsilateral malignancies with either incidental or targeted RSL needle biopsy results. This suggests that patients with RSL without atypia on needle biopsy may not require surgical excision.

RSL are frequently encountered on needle biopsy and have commonly been recommended for surgical excision. These results suggest patients may be able to avoid surgery in this setting.

Kalife, E, Lourenco, A, Resnick, M, Mainiero, M, Wang, Y, Radial Sclerosing Lesions without Atypia on Core Needle Biopsy: Excision or Observation.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014765.html