Radial Scars Without Atypia Diagnosed at Percutaneous Core Needle Breast Biopsy: Support for Imaging Surveillance.

Dogan S Polat, Stephen J Seiler, Jordan Goldberg, Rishi Arya, Emily E Knippa, Sally H Goudreau
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Abstract

Objective: Radial scar (RS) is a low-risk breast lesion that can be associated with or mimic malignancy. Management guidelines remain controversial for patients with RS without atypia on core needle biopsy (CNB). The aim was to evaluate the upgrade rate of these lesions and factors associated with malignancy risk and excision rate to more definitively guide management.

Materials and methods: In this retrospective study, 123 patients with RS without atypia, diagnosed with CNB between January 2008 to December 2014 who were either referred for surgical excision or followed-up with imaging, were reviewed. The differences in clinical presentation, imaging features, and biopsy technique among the benign RS patients and those upgraded, as well as the excised versus the observed patients were compared.

Results: Of 123 RS reviewed, 93 cases of RS without atypia as the highest-grade lesion in the ipsilateral breast and with either 24-month imaging follow-up or surgical correlation were included. Seventy-four (79.6%) lesions were surgically excised and 19 (20.4%) were followed-up for at least 24 months. A single upgrade to malignancy (1%) and 15 upgrades to high-risk lesions (16%) were found. There was no association of any upgraded lesion with presenting symptoms or imaging features. The use of vacuum-assistance and larger biopsy needles, along with obtaining a higher number of samples, was associated with fewer upgrades and lower surgical excision rates.

Conclusion: The upgrade rate of RS without atypia in our population was low, regardless of the imaging features and biopsy technique utilized. Close imaging surveillance is an acceptable alternative to surgical excision in these patients.

经皮核针乳腺活检诊断无异型性的放射状疤痕:支持影像监测。
目的:放射状瘢痕(RS)是一种低风险的乳房病变,可与恶性肿瘤相关或类似恶性肿瘤。对于核心穿刺活检(CNB)无异型性RS患者的管理指南仍存在争议。目的是评估这些病变的升级率以及与恶性肿瘤风险和切除率相关的因素,以更明确地指导治疗。材料与方法:回顾性分析2008年1月至2014年12月诊断为CNB的无异型RS患者123例,均行手术切除或影像学随访。比较良性RS患者与升级RS患者的临床表现、影像学特征和活检技术的差异,以及切除RS患者与观察RS患者的差异。结果:在123例RS中,93例非异型性RS为同侧乳腺最高级别病变,并有24个月的影像学随访或手术相关性。74例(79.6%)病灶手术切除,19例(20.4%)随访至少24个月。1例升级为恶性肿瘤(1%),15例升级为高危病变(16%)。没有任何病变升级与表现症状或影像学特征的关联。使用真空辅助和更大的活检针,以及获得更多的样本,与更少的升级和更低的手术切除率相关。结论:无论影像学特征和活检技术如何,我们人群中无异型性RS的升级率都很低。在这些患者中,密切影像监测是手术切除的可接受的替代方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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