Management of radial scars/complex sclerosing lesions of the breast diagnosed on vacuum-assisted large-core biopsy: is surgery always necessary?
Adult
Aged
Biopsy, Large-Core Needle
Breast
/ diagnostic imaging
Breast Neoplasms
/ diagnostic imaging
Cicatrix
/ pathology
Female
Fibrocystic Breast Disease
/ diagnostic imaging
Humans
Mammography
Middle Aged
Precancerous Conditions
/ diagnostic imaging
Retrospective Studies
Risk Factors
Sclerosis
/ diagnostic imaging
atypia
complex sclerosing lesion
radial scar
surgical excision
vacuum-assisted large-core biopsy
Journal
Histopathology
ISSN: 1365-2559
Titre abrégé: Histopathology
Pays: England
ID NLM: 7704136
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
05
05
2019
revised:
10
06
2019
accepted:
04
07
2019
pubmed:
10
7
2019
medline:
28
4
2020
entrez:
10
7
2019
Statut:
ppublish
Résumé
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. 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). 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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
900-915Informations de copyright
© 2019 John Wiley & Sons Ltd.
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