Six cases showing radial scar/complex sclerosing lesions of the breast detected by breast cancer screening

Inoue, Satoshi; Inoue, M.; Kawasaki, Tomonori; Takahashi, Hifumi; Inoue, Ayako; Maruyama, Takanori; Matsuda, Kei; Kunitomo, Kazuyoshi; Murata, Shin‐ichi; Fujii, Hideki

doi:10.1007/s12282-008-0035-2

Cited by 8 publications

(5 citation statements)

References 19 publications

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“…Sclerosing lesions such as sclerosing adenosis and radial scar were nearly three times as common in the screening population compared to the symptomatic group. These complex lesions were placed in the C3 category because of the high cellularity of the sample and a milieu of conflicting microscopic features, and were accompanied by heightened radiological suspicion [45,46,47]. Proliferative fibrocystic change was nearly twice as common in the screening population as in the symptomatic group.…”

Section: Discussionmentioning

confidence: 99%

The True Nature of Atypical Breast Cytology

Weigner

Zardawi²,

Braye³

2013

Acta Cytologica

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Background: Atypical breast cytology is a poorly understood heterogeneous category with limited clinical utility but significant implications for patient management. Objective: To provide an insight into the true nature of atypical breast cytology in screening-detected (asymptomatic) and symptomatic settings, and find strategies for reducing the use of this diagnostic category. Materials and Methods: A total of 6,415 breast cytology samples were processed between January 2004 and December 2008. An atypical cytological diagnosis was rendered in 256 (4%) of the cases. A blind microscopic review of the atypical cases was conducted and results were correlated with subsequent histological and/or clinical outcomes. Results: Follow-up information by histology was available in 85.5%, by repeat fine-needle aspiration (FNA) in 3.5% and by imaging or clinical follow-up in 10.2% of the cases. Two patients (0.8%) were lost to follow-up. Of the 254 cases with follow-up, 62.6% were benign and 37.4% were malignant. The benign to malignant ratios were 1:1 and 2:1 in the screening and symptomatic groups, respectively. The atypical category in the screening population mostly yielded fat necrosis, complex sclerosing lesions and low- to intermediate-grade carcinoma on follow-up. The main outcomes in the symptomatic group were papilloma, fibroadenoma, ductal carcinoma in situ and lobular carcinoma. Preanalytical (suboptimal samples) factors were encountered in 34.8% and interpretative factors in 65.2% of the cases. Uncertainty about cellular morphology was attributed to such a diagnosis in 38 (14.8%) of the cases, architectural complexity in 137 (53.5%) and morphology and architecture in 70 (27.3%); 4.3% of cases were considered nondiagnostic. Conclusion: The atypical category is a necessary diagnosis but of limited use from a patient management perspective. Some preanalytical factors such as poor sample quality can be minimized by the involvement of cytopathologists in the FNA procedure. The use of the atypical category is partly dependent on the experience and confidence of the reporting pathologist. Assigning a case to this category is also likely to be unduly influenced by clinical or radiological findings. Our study indicates that the use of the atypical category can be reduced by up to 40% by appreciating these contributing factors. The practical utilization of the atypical category in breast cytology remains subjective and further study is required to identify useful objective criteria.

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Section: Discussionmentioning

confidence: 99%

The True Nature of Atypical Breast Cytology

Weigner

Zardawi²,

Braye³

2013

Acta Cytologica

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“…Therefore, in addition to the later risk of breast cancer, there is a risk of missing a coexisting carcinoma when an RS/CSL is diagnosed on percutaneous biopsy. Many cases of pure RS/CSL on percutaneous biopsy that were upgraded to carcinoma upon subsequent surgical excision have been reported . Consequently, surgical excision is usually performed .…”

Section: Introductionmentioning

confidence: 99%

Management of radial scars/complex sclerosing lesions of the breast diagnosed on vacuum‐assisted large‐core biopsy: is surgery always necessary?

et al. 2019

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Aims The diagnosis of radial scars/complex sclerosing lesions (RSs/CSLs) onpercutaneous biopsy carries a risk of histological underestimation. Consequently, surgical excision is often performed in order to exclude a possible associated malignancy. The aim of this study was to assess the rate of ‘upgrade to carcinoma’ upon subsequent surgical excision of RS/CSL cases diagnosed on vacuum‐assisted large‐core biopsy (VALCB). We also analysed the risk factors for upgrade in order to determine a subset of patients who could avoid surgery and benefit from conservative management with clinical and imaging follow‐up. Methods and results This was a retrospective observational single‐centre study on 174 consecutive RS/CSL cases diagnosed on VALCB from May 2008 to October 2015. Univariate analysis was performed to identify clinical, radiological and histological risk factors for upgrade. Surgical excision was performed following VALCB diagnosis of 88 RS/CSL cases with or without associated atypia. The overall rate of surgical upgrade to carcinoma was 9.1% (8/88). None of the benign biopsies without atypia was surgically upgraded. Additional to atypia, risk factors for upgrade were non‐incidental finding of the RS/CSL, the mammographic appearance, and the number of fragments obtained during the biopsy procedure (P < 0.05). Conclusion We demonstrate that VALCB revealing an RS/CSL is reliable for excluding malignancy when there is no associated atypia and when radiological and histological findings are concordant. In such cases, surgery can be avoided in favour of clinical and imaging follow‐up. When an RS/CSL is associated with atypia, the decision to perform surgical excision depends on other associated risk factors.

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“…The other patients exhibited focal asymmetry (n=1) and architectural distortion (n=2) with a central radiolucent area. Radial scars commonly present as asymmetric densities or architectural distortions with central translucent areas [8,15]. Long, radiating spicules against a background of radiolucent fat create a black, star-like appearance [8,16].…”

Section: Discussionmentioning

confidence: 99%

Imaging features of complex sclerosing lesions of the breast

et al. 2013

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Purpose:The purpose of this study was to evaluate the imaging features of complex sclerosing lesions of the breast and to assess the rate of upgrade to breast cancer.Methods:From March 2008 to May 2012, seven lesions were confirmed as complex sclerosing lesions by ultrasonography-guided core needle biopsy. Final results by either surgical excision or follow-up imaging studies were reviewed to assess the rate of upgrade to breast cancer. Two radiologists retrospectively analyzed the imaging findings according to the Breast Imaging Reporting and Data System classification. Results:Five lesions underwent subsequent surgical excision and two of them revealed ductal carcinoma in situ (n=1) and invasive ductal carcinoma (n=1). Our study showed a breast cancer upgrade rate of 28.6% (2 of 7 lesions). Two lesions were stable on imaging follow-up beyond 1 year. The mammographic features included masses (n=4, 57.1%), architectural distortion (n=2, 28.6%), and focal asymmetry (n=1, 14.3%). Common B-mode ultrasonographic features were irregular shape (n=6, 85.7%), spiculated margin (n=5, 71.4 %), and hypoechogenicity (n=7, 100%). The final assessment categories were category 4 (n=6, 85.7%) and category 5 (n=1, 14.3%).Conclusion:The complex sclerosing lesions were commonly mass-like on mammography and showed the suspicious ultrasonographic features of category 4. Due to a high underestimation rate, all complex sclerosing lesions by core needle biopsy should be excised.

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Six cases showing radial scar/complex sclerosing lesions of the breast detected by breast cancer screening

Cited by 8 publications

References 19 publications

The True Nature of Atypical Breast Cytology

The True Nature of Atypical Breast Cytology

Management of radial scars/complex sclerosing lesions of the breast diagnosed on vacuum‐assisted large‐core biopsy: is surgery always necessary?

Imaging features of complex sclerosing lesions of the breast

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