A review of needle core biopsy diagnosed radial scars in the Welsh Breast Screening Programme

Osborn, Gary; Wilton, F; Stevens, G. Melvin; Vaughan-Williams, E.; Gower-Thomas, K

doi:10.1308/003588411x12851639107953

Cited by 36 publications

(15 citation statements)

References 19 publications

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“…This approach also can assist in identifying newly-colonized areas, movement corridors, and potential pathways of dispersal. More precise information on the presence of invasive constrictors in imperiled ecosystems can inform spatiotemporal assessment of risk to imperiled native species (e.g., ground-dwelling birds, Key Largo woodrat ( Neotoma floridana smalli ), Florida panther ( Puma concolor )), and potentially allow for targeted removal efforts prior to realization of major ecological and economic impacts [ 15 – 17 ]. Environmental DNA tools also could assist with short- or long-term monitoring to assess the success of control or eradication efforts.…”

Section: Introductionmentioning

confidence: 99%

Environmental DNA (eDNA) Sampling Improves Occurrence and Detection Estimates of Invasive Burmese Pythons

et al. 2015

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Environmental DNA (eDNA) methods are used to detect DNA that is shed into the aquatic environment by cryptic or low density species. Applied in eDNA studies, occupancy models can be used to estimate occurrence and detection probabilities and thereby account for imperfect detection. However, occupancy terminology has been applied inconsistently in eDNA studies, and many have calculated occurrence probabilities while not considering the effects of imperfect detection. Low detection of invasive giant constrictors using visual surveys and traps has hampered the estimation of occupancy and detection estimates needed for population management in southern Florida, USA. Giant constrictor snakes pose a threat to native species and the ecological restoration of the Florida Everglades. To assist with detection, we developed species-specific eDNA assays using quantitative PCR (qPCR) for the Burmese python (Python molurus bivittatus), Northern African python (P. sebae), boa constrictor (Boa constrictor), and the green (Eunectes murinus) and yellow anaconda (E. notaeus). Burmese pythons, Northern African pythons, and boa constrictors are established and reproducing, while the green and yellow anaconda have the potential to become established. We validated the python and boa constrictor assays using laboratory trials and tested all species in 21 field locations distributed in eight southern Florida regions. Burmese python eDNA was detected in 37 of 63 field sampling events; however, the other species were not detected. Although eDNA was heterogeneously distributed in the environment, occupancy models were able to provide the first estimates of detection probabilities, which were greater than 91%. Burmese python eDNA was detected along the leading northern edge of the known population boundary. The development of informative detection tools and eDNA occupancy models can improve conservation efforts in southern Florida and support more extensive studies of invasive constrictors. Generic sampling design and terminology are proposed to standardize and clarify interpretations of eDNA-based occupancy models.

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Section: Introductionmentioning

confidence: 99%

Environmental DNA (eDNA) Sampling Improves Occurrence and Detection Estimates of Invasive Burmese Pythons

et al. 2015

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“…[15] The high-risk lesion and cancer upstage rate in follow-up excisional biopsies ranged from 3% – 46% in several reports. [2, 5, 6, 8–10, 12, 13, 17, 18, 25]…”

Section: Discussionmentioning

confidence: 99%

“…[5] The pathogenesis of RS is uncertain. Reaction to an unknown trauma which results in scarring with elastosis or inflammation have been hypothesized.…”

Section: Introductionmentioning

confidence: 99%

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Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution

Nassar

Conners

Çelik

et al. 2015

Annals of Diagnostic Pathology

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Background Radial scars (RS) or complex sclerosing lesions (CSL) of the breast are benign radiological and histological entities. Radiologically, they appear as architectural distortion with central radiolucency. These stellate lesions are frequently identified on screening mammography and, with the introduction of population-based screening programs; their incidence has increased to 0.03%–0.09% of all core needle biopsies (CNB). However, they can pose diagnostic difficulty as their radiologic and histologic appearance mimic carcinoma. Because of the high incidence of atypia or associated occult malignancy, the current literature recommendation is excision of all mammographically detected RS/CSL diagnosed on CNB. Aims and Objective Our aim was to review all RS/CSL that were previously diagnosed on image-guided CNB from January 1st, 1994 to August 31st, 2013, and assess the pathology from the excisional biopsy to identify cases upstaged to atypia or neoplasm. Results There were a total of 113 CNB from 109 women with radial scar without concomitant atypia on CNB diagnosed during that period; five cases were excluded because of concurrent cancer. Average age of these women was 52.9 years (range: 23.0 – 82.0 years). Thirty-five women (38/100 CNB; 38.0%) have follow-up excision. The median size of the excised radial scars is 1.2 cm (range: 0.4 – 3.3 cm). More than two-thirds of excised cases (68.6%; 24/35) were greater than 1.0 cm. The mammographic and ultrasonographic imaging features were listed as architectural distortion in 53.1% (17/32) and hypoechoic nodules with irregular margins in 36.4% (12/33) respectively. Almost all excised cases 91.7%; 33/36) showed radiologic and pathologic concordance, and more than three-quarters (23/29; 79.3%) are designated as Bi-Rads level 4 (suspicious for malignancy). The 38 follow-up excisional biopsies revealed: 2 (5.3%) invasive mammary carcinomas (2 metaplastic carcinomas including adenoid cystic carcinoma); 2 (5.3%) in-situ ductal carcinoma; 1 (2.6%) lobular carcinoma in-situ; 5 (13.2%) atypical lobular hyperplasia; 1 (2.6%) atypical ductal hyperplasia; 22 (57.9%) residual radial scars; and 5 (13.2%) with no residual lesions on follow-up. Conclusion Follow-up excisional biopsy is warranted for RS/CSL specifically if they are larger than 1.0 cm with worrisome radiographic images or showed radiologic and pathologic discordance, as approximately 29% (11/38) of these cases will have an upgrade to in-situ or invasive carcinomas or other high risk lesions on follow-up.

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“…Historical literature suggests that these lesions are associated with considerable risk of finding breast carcinoma in adjacent tissue, prompting recommendation for excision . The reported incidence of malignancy on excisional specimens following a diagnosis of CSL/RSL on core needle biopsy varies widely, between 0% and 23% …”

Section: Introductionmentioning

confidence: 99%

Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: Low risk of carcinoma on excision in cases with clinical and imaging concordance

et al. 2017

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Complex or radial sclerosing lesions (CSL/RSL) are uncommon diagnoses on core needle biopsy with a reported upgrade rate ranging between 0% and 23%. As a result, their management remains controversial. In this study, we sought to determine the rate of malignancy on excision for patients with pure CSL/RSL on core biopsy, and to evaluate future breast cancer risk when CSL/RSL is managed without excision. We retrospectively reviewed 118 cases of CSL/RSL diagnosed on image-guided breast biopsies between 2005 and 2014 at our institution. Of 98 analyzed patients, 34 (35%) underwent excision and 64 (65%) were observed. Demographic and clinical variables between excision and observation groups were compared. In excised specimens, factors associated with upgrade to malignancy were evaluated. The median age at diagnosis was 49 years (range, 27-88 years). In the excision group, 3/34 cases were associated with malignancy, an overall upgrade rate of 9%. All malignant cases had core needle biopsies interpreted as discordant and were BIRADS 4B or more on imaging. In the observation group, at a median follow-up of 2.2 years, 3/64 (5%) patients developed ipsilateral cancers, all of which were distant from the index CSL/RSL. In our series, we report a 9% malignancy rate on excision of BIRADS >4C lesions characterized as CSL/RSL on core biopsy. In patients with concordant biopsies and BIRADS 4A or lower lesions who underwent observation, we found a low rate of subsequent ipsilateral cancers. Further studies are needed to confirm that for CSL/RSL in concordant core biopsies and BIRADS 4A or lower, nonpalpable lesions, observation may be a reasonable alternative to excision.

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A review of needle core biopsy diagnosed radial scars in the Welsh Breast Screening Programme

Cited by 36 publications

References 19 publications

Environmental DNA (eDNA) Sampling Improves Occurrence and Detection Estimates of Invasive Burmese Pythons

Environmental DNA (eDNA) Sampling Improves Occurrence and Detection Estimates of Invasive Burmese Pythons

Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution

Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: Low risk of carcinoma on excision in cases with clinical and imaging concordance

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