Percutaneous Core Needle Biopsy of Radial Scars of the Breast: When Is  Excision Necessary?

Brenner, R. James; Jackman, Roger J.; Parker, Steve H.; Evans, W. P.; Philpotts, Liane E.; Deutch, B M; Lechner, Mary C.; Lehrer, Daniel E.; Sylvan, Paul; Hunt, R. Thomas N.; Adler, Steven; Forcier, Nancy J.

doi:10.2214/ajr.179.5.1791179

Cited by 208 publications

(124 citation statements)

References 31 publications

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“…These are more likely to be incidental in nature and their management is most controversial. The mean size of radial scars in our series was 3.11 mm, while those in other reports 3,5,7,8,11,17,18 range in size from 1 mm up to 5.0 cm. This wide range in sizes is a result of variability of inclusion criteria among different studies.…”

Section: Commentcontrasting

confidence: 68%

“…In most studies, the rate of upgrade, or underestimation of malignancy, of surgically excised radial scars has been variable, but most reported rates are in the range of 0% to 10%. 3,[5][6][7][8][9][10][11][12][13][14] However, most radiologists are not comfortable recommending clinical follow-up over surgical excision of radial scars because studies have not consistently demonstrated an upgrade rate of less than 2%, the cutoff for categorizing a lesion as ''probably benign'' according to the BI-RADS (Breast Imaging Reporting and Data System) system (BI-RADS 3). 15 The variability in reported upgrade rates may be due to several factors including variability in study design, small sample sizes, and inconsistent radiologic-pathologic concordance.…”

Section: Commentmentioning

confidence: 99%

“…Another strength of this study is the detailed pathologic correlation that is generally lacking from many published studies examining this clinical scenario. 5,8,16 Our study is among few based on a cohort of patients with histopathologically confirmed radial scars. While it is intuitively obvious to maintain a pure study group, this necessary step is not performed in all studies.…”

Section: Commentmentioning

confidence: 99%

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Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases

Matrai¹,

D’Alfonso²,

Drotman³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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Context Radial scars are benign sclerosing lesions that are routinely excised when diagnosed in a needle core biopsy. Optimal management for patients with incidental and small (≤5 mm) radial scars is uncertain. Objective To assess pathologic upgrade of radial scars diagnosed in needle core biopsy samples and identify a subset of patients who could benefit from conservative management. Design Patients with a diagnosis of radial scar in a needle core biopsy who underwent excision of the biopsied area were identified. Radial scars greater than 5 mm in size and those with coexisting atypia, carcinoma, and papillary lesions were excluded. After histologic-radiographic correlation, rates of pathologic upgrade were assessed. Results Seventy-seven radial scars diagnosed in 66 patients were included. Overall, 9 of 77 (12%) showed upgrade to a high-risk lesion (6 lobular carcinoma in situ, 2 atypical ductal hyperplasia, 1 atypical lobular hyperplasia), while none (0%) showed upgrade to invasive carcinoma or ductal carcinoma in situ. One of 22 incidental radial scars (4.5%) showed upgrade on excision versus 6 of 36 (16.7%) for radial scars considered to be the radiographic target (P = .23). Older age was associated with upgrade (P < .001). Conclusions No incidental or small (≤5 mm) radial scars excised revealed invasive carcinoma or ductal carcinoma in situ on excision. Provided there is good pathologic-radiologic concordance, it appears reasonable for these patients to be managed conservatively.

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Section: Commentcontrasting

confidence: 68%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases

Matrai¹,

D’Alfonso²,

Drotman³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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“…The biopsy type, the volume of the sample and the experience of the operator can all affect the accuracy of a core needle biopsy (21)(22)(23)(24). Core needle biopsies can be sufficient for the diagnosis of small spiculated lesions such as focal architectural distortions or radial sclerosing lesions (25,26). In this study, all microcalcification clusters and most of the focal architectural distortion areas and spiculated lesions were surgically excised after needle wire localization to guarantee sample adequacy and to prevent possible problems related to poor localization.…”

Section: Core Needle Biopsy Cases Study Group (41)mentioning

confidence: 99%

Sclerosing adenosis of the breast: radiographic appearance and efficiency of core-needle biopsy

Taşkın

Köseoğlu²,

Ünsal³

et al. 2011

Diagn Interv Radiol

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“…36 In some centres, however, the imaging suggestion of a radial scar is followed by surgical excision without pre-operative CNB.…”

Section: Radial Scarmentioning

confidence: 99%

Breast core needle biopsy: issues and controversies

Bilous

2010

Modern Pathology

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Core needle biopsy (CNB) is increasingly being used in the investigation of breast disease whether this is asymptomatic and suspected after screening mammography, or presents symptomatically in the patient. In most cases, the result of the procedure provides a definitive diagnosis or at least provides information that is used to plan the further management of the patient. There are, however, a number of unresolved issues with the use of CNB; for example, with regard to the amount of information that can be reliably derived from CNB or with regard to the management of the patient after some CNB diagnoses. Oestrogen and progesterone receptors and HER2 are reported on both core biopsies and excision specimens, but there continues to be debate over which represents the more appropriate specimen type on which to perform these tests. There are a number of possible diagnoses after CNB for which the management is not straightforward and around which there may be controversy, or just a lack of sufficient evidence to support a definite management plan. These 'lesions of uncertain malignant potential' include papillary lesions, fibroepithelial lesions with cellular stroma, mucocoelelike lesions and radial scars. Currently, these are removed surgically but there may be an argument for more conservative management including vacuum-assisted core excision in some cases.

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Percutaneous Core Needle Biopsy of Radial Scars of the Breast: When Is Excision Necessary?

Cited by 208 publications

References 31 publications

Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases

Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases

Sclerosing adenosis of the breast: radiographic appearance and efficiency of core-needle biopsy

Breast core needle biopsy: issues and controversies

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