Radial Scar: a management dilemma

Trombadori, Charlotte Marguerite Lucille; D’Angelo, Anna; Ferrara, Francesca; Santoro, Angela; Belli, Paolo; Manfredi, Riccardo

doi:10.1007/s11547-021-01344-w

Cited by 24 publications

(18 citation statements)

References 67 publications

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“…There has been work done for uniform, reproducible guidelines for recognition of these lesions on imaging. 14 World Health Organization (WHO) in 2012 set out guidelines recommending close surveillance of RS/CSL should the area of concern be excised completely with vacuum-assisted biopsy and no atypia found in the specimen. 15 A panel of international breast ultrasound experts rendered a consensus recommending therapeutic excision with vacuum-assisted biopsy, with subsequent surveillance.…”

Section: Discussionmentioning

confidence: 99%

Upstage Rate of Complex Sclerosing Lesions/Radial Scars

Jones

Pearce

Khalil

et al. 2022

The American Surgeon

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Background Radial scars (RS) and complex sclerosing lesions (CSL) are breast radiologic findings described as small, stellate lesions causing architectural distortion. This can mimic malignancy. Core needle biopsy (CNB) is often performed. Advances in breast imaging have led to increased detection of RS/CSL. The upstage rate of RS/CSL to in situ or invasive disease is 0-40%. We sought to determine the upstaging rate of RS/CSL to in situ, invasive disease, or high-risk lesion at our institution to create excision guidelines. Methods The pathology database of a single center was searched for RS/CSL, from January 2013 to September 2020. We included CNB without malignancy or high-risk lesion (eg, atypical ductal hyperplasia). Patient demographics, indications for biopsy, imaging findings, biopsy procedure, and final pathology were collected. Results Forty-four patients were included. 52.3% had CNB for architectural distortion on mammography, 18.2% for mass, 11.4% for calcifications, 2.3% for abnormal MRI, and 15.9% for multiple reasons (eg, calcifications and mass). Most had an ultrasound: 43.2% had no abnormality and 34.1% had a mass. All CNB were vacuum assisted, 65.9% with 9-gauge needle, and averaged 10.0 cores. 77.3% were stereotactic biopsies, 13.6% ultrasound, and 6.8% MRI. 59.1% had excision after CNB. 82.1% of patients did not upstage. One patient upstaged to invasive ductal carcinoma (3.6%) and two patients to high-risk lesion (7.1%). Discussion There was low upstage rate of RS/CSL on excisional biopsy. Centers could consider close surveillance for RS/CSL on CNB. Longer follow-up in cases of deferred excision is needed to ensure oncologic safety.

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Section: Discussionmentioning

confidence: 99%

Upstage Rate of Complex Sclerosing Lesions/Radial Scars

Jones

Pearce

Khalil

et al. 2022

The American Surgeon

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“…Both US-LI-RADS and diagnostic LI-RADS do not address patients with vascular causes of liver cirrhosis (e.g., cardiac hepatopathy, Budd–Chiari syndrome) because these conditions are associated with hypervascular benign liver lesions, which increase the risk of false positives and reduce the PPV for the diagnosis of HCC [ 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 ]. Although with some regional differences, patients with hepatitis C in the absence of cirrhosis and adults with nonalcoholic steatohepatitis are not included in the screening.…”

Section: Li-radsmentioning

confidence: 99%

A Narrative Review on LI-RADS Algorithm in Liver Tumors: Prospects and Pitfalls

et al. 2022

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Liver cancer is the sixth most detected tumor and the third leading cause of tumor death worldwide. Hepatocellular carcinoma (HCC) is the most common primary liver malignancy with specific risk factors and a targeted population. Imaging plays a major role in the management of HCC from screening to post-therapy follow-up. In order to optimize the diagnostic-therapeutic management and using a universal report, which allows more effective communication among the multidisciplinary team, several classification systems have been proposed over time, and LI-RADS is the most utilized. Currently, LI-RADS comprises four algorithms addressing screening and surveillance, diagnosis on computed tomography (CT)/magnetic resonance imaging (MRI), diagnosis on contrast-enhanced ultrasound (CEUS) and treatment response on CT/MRI. The algorithm allows guiding the radiologist through a stepwise process of assigning a category to a liver observation, recognizing both major and ancillary features. This process allows for characterizing liver lesions and assessing treatment. In this review, we highlighted both major and ancillary features that could define HCC. The distinctive dynamic vascular pattern of arterial hyperenhancement followed by washout in the portal-venous phase is the key hallmark of HCC, with a specificity value close to 100%. However, the sensitivity value of these combined criteria is inadequate. Recent evidence has proven that liver-specific contrast could be an important tool not only in increasing sensitivity but also in diagnosis as a major criterion. Although LI-RADS emerges as an essential instrument to support the management of liver tumors, still many improvements are needed to overcome the current limitations. In particular, features that may clearly distinguish HCC from cholangiocarcinoma (CCA) and combined HCC-CCA lesions and the assessment after locoregional radiation-based therapy are still fields of research.

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“…Ultrasound (US) is an imaging tool is cheap, noninvasive, non-irradiating and, thus, repeatable, suitable for patient disease monitoring [22][23][24][25]. Contrast-Enhanced Ultrasound (CEUS) imaging is an improved ultrasound-based technology, assuming the injection into the blood of a specific contrast agent, consisting of gas filled microbubbles [22].…”

Section: Diagnostic Tools Ultrasoundmentioning

confidence: 99%

Diagnostic evaluation and ablation treatments assessment in hepatocellular carcinoma

Granata

Grassi

Fusco³

et al. 2021

Infect Agents Cancer

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This article provides an overview of diagnostic evaluation and ablation treatment assessment in Hepatocellular Carcinoma (HCC). Only studies, in the English language from January 2010 to January 202, evaluating the diagnostic tools and assessment of ablative therapies in HCC patients were included. We found 173 clinical studies that satisfied the inclusion criteria.HCC may be noninvasively diagnosed by imaging findings. Multiphase contrast-enhanced imaging is necessary to assess HCC. Intravenous extracellular contrast agents are used for CT, while the agents used for MRI may be extracellular or hepatobiliary. Both gadoxetate disodium and gadobenate dimeglumine may be used in hepatobiliary phase imaging. For treatment-naive patients undergoing CT, unenhanced imaging is optional; however, it is required in the post treatment setting for CT and all MRI studies. Late arterial phase is strongly preferred over early arterial phase. The choice of modality (CT, US/CEUS or MRI) and MRI contrast agent (extracelllar or hepatobiliary) depends on patient, institutional, and regional factors. MRI allows to link morfological and functional data in the HCC evaluation. Also, Radiomics is an emerging field in the assessment of HCC patients.Postablation imaging is necessary to assess the treatment results, to monitor evolution of the ablated tissue over time, and to evaluate for complications. Post- thermal treatments, imaging should be performed at regularly scheduled intervals to assess treatment response and to evaluate for new lesions and potential complications.

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Radial Scar: a management dilemma

Cited by 24 publications

References 67 publications

Upstage Rate of Complex Sclerosing Lesions/Radial Scars

Upstage Rate of Complex Sclerosing Lesions/Radial Scars

A Narrative Review on LI-RADS Algorithm in Liver Tumors: Prospects and Pitfalls

Diagnostic evaluation and ablation treatments assessment in hepatocellular carcinoma

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