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01-01-2019 | Review

Rate of radial scars by core biopsy and upgrading to malignancy or high-risk lesions before and after introduction of digital breast tomosynthesis

Authors: April Phantana-angkool, Meghan R. Forster, Yancey E. Warren, Chad A. Livasy, Amy H. Sobel, Lakesha M. Beasley, Sally J. Trufan, Lejla Hadzikadic-Gusic, Terry Sarantou, Amy E. Voci, Deba Sarma, Richard L. White Jr.

Published in: Breast Cancer Research and Treatment | Issue 1/2019

Abstract

Purpose

Radial scars (RS) commonly present mammographically as architectural distortions, but these lesions may be associated with non-invasive and invasive breast cancer. Digital breast tomosynthesis (DBT) has resulted in higher detection rates of architectural distortion particularly in patients with dense breast tissue. We hypothesized that rates of clinically relevant lesions confirmed surgically would be lower in patients who received DBT imaging compared with those who received standard digital breast imaging.

Methods

We performed a retrospective review of 223 patients diagnosed with pure RS by core biopsy and surgical excision before and after DBT was introduced. The rate of upgrading to malignancy or high-risk lesion was evaluated. Demographics, biopsy type, and histologic data were analyzed. Univariable logistic regression analysis was used to identify variables that may be associated with upgrading.

Results

The rate of identifying RS increased from 0.04–.13% (P < 0.0001) with DBT imaging. The upgrade rate on surgical specimen to invasive or non-invasive cancer was similar before and after DBT; 6% versus 3%, as were findings of a high-risk lesion; 12% versus 22%. No predictive factors were identified for patients upgraded to malignant neoplasms or high-risk lesions.

Conclusions

The likelihood of identifying RS has increased with DBT imaging, but rates of upgrading to a malignant neoplasm or high-risk lesion were similar to those before DBT. Although the rate of upgrading to malignancy after DBT was low, an excisional biopsy should be considered as 22% of patients were upgraded to high-risk lesions. These patients are candidates for chemoprevention and/or high-risk surveillance.

Schnitt S, Collins L (2017) Biopsy interpretation of the breast. vol 63. 3rd edn. (Epstein J (ed)). Boston: LWW; 2017

Tabar L, Dean P (2012) Teaching atlas of mammography, 4th edn. Thieme, New York

Orel SG, Evers K, Yeh IT, Troupin RH (1992) Radial scar with microcalcifications: radiologic-pathologic correlation. Radiology 183(2):479–482. https://doi.org/10.1148/radiology.183.2.1561353 CrossRefPubMed

Gaur S, Dialani V, Slanetz PJ, Eisenberg RL (2013) Architectural distortion of the breast. Am J Roentgenol 201(5):662–670. https://doi.org/10.2214/AJR.12.10153 CrossRef

Jackman RJ, Nowels KW, Rodriguez-Soto J, Marzoni FA, Finkelstein SI, Shepard MJ (1999) Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up. Radiology 210(3):799–805. https://doi.org/10.1148/radiology.210.3.r99mr19799 CrossRefPubMed

Philpotts LE, Shaheen NA, Jain KS et al (2000) Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology 216(3):831–837. https://doi.org/10.1148/radiology.216.3.r00se31831 CrossRefPubMed

Linda A, Zuiani C, Furlan A et al (2010) Radial scars without atypia diagnosed at imaging-guided needle biopsy: how often is associated malignancy found at subsequent surgical excision, and do mammography and sonography predict which lesions are malignant? Am J Roentgenol 194(4):1146–1151. https://doi.org/10.2214/AJR.09.2326 CrossRef

Brenner RJ, Jackman RJ, Parker SH et al (2002) Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? Am J Roentgenol 179(5):1179–1184. https://doi.org/10.2214/ajr.179.5.1791179 CrossRef

Miller CL, West JA, Bettini AC et al (2014) Surgical excision of radial scars diagnosed by core biopsy may help predict future risk of breast cancer. Br Cancer Res Treat 145(2):331–338. https://doi.org/10.1007/s10549-014-2958-y CrossRef

10.

Conlon N, D’Arcy C, Kaplan JB et al (2015) Radial scar at image-guided needle biopsy: is excision necessary? Am J Surg Pathol 39(6):779–785. https://doi.org/10.1097/PAS.0000000000000393 CrossRefPubMedPubMedCentral

11.

Matrai C, D’alfonso TM, Pharmer L et al (2015) Advocating nonsurgical management of patients with small, incidental radial scars at the time of needle core biopsy A Study of 77 cases. Arch Pathol Lab Med 139(9):1137–1142. https://doi.org/10.5858/arpa.2014-0550-OA CrossRefPubMed

12.

Kim EMH, Hankins A, Cassity J et al (2016) Isolated radial scar diagnosis by core-needle biopsy: is surgical excision necessary? Springerplus 5(1):398. https://doi.org/10.1186/s40064-016-1993-z CrossRefPubMedPubMedCentral

13.

Li Z, Ranade A, Zhao C (2016) Pathologic findings of follow-up surgical excision for radial scar on breast core needle biopsy. Hum Pathol 48:76–80. https://doi.org/10.1016/j.humpath.2015.06.028 CrossRefPubMed

14.

Chou WYY, Veis DJ, Aft R (2018) Radial scar on image-guided breast biopsy: is surgical excision necessary? Breast Cancer Res Treat 170(2):313–320. https://doi.org/10.1007/s10549-018-4741-y CrossRefPubMedPubMedCentral

15.

López-Medina A, Cintora E, Múgica B et al (2006) Radial scars diagnosed at stereotactic core-needle biopsy: surgical biopsy findings. Eur Radiol 16(8):1803–1810. https://doi.org/10.1007/s00330-006-0196-3 CrossRefPubMed

16.

Miller CL, West JA, Bettini AC et al (2014) Surgical excision of radial scars diagnosed by core biopsy may help predict future risk of breast cancer. Breast Cancer Res Treat 145(2):331–338. https://doi.org/10.1007/s10549-014-2958-y CrossRefPubMed

17.

Andacoglu O, Kanbour-Shakir A, Teh YC et al (2013) Rationale of excisional biopsy after the diagnosis of benign radial scar on core biopsy: a single institutional outcome analysis. Am J Clin Oncol Cancer Clin Trials 36(1):7–11. https://doi.org/10.1097/COC.0b013e3182354a3f CrossRef

18.

Noroozian M, Hadjiiski L, Rahnama-Moghadam S et al (2012) Digital breast tomosynthesis is comparable to mammographic spot views for mass characterization. Radiology 262(1):61–68. https://doi.org/10.1148/radiol.11101763 CrossRefPubMedPubMedCentral

19.

Zuley ML, Bandos AI, Ganott MA et al (2013) Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions. Radiology 266(1):89–95. https://doi.org/10.1148/radiol.12120552 CrossRefPubMedPubMedCentral

20.

Hooley RJ, Durand MA, Philpotts LE (2017) Advances in digital breast tomosynthesis. Am J Roentgenol 208(2):256–266. https://doi.org/10.2214/AJR.16.17127 CrossRef

21.

Lourenco AP, Barry-Brooks M, Baird G et al (2015) Changes in recall type and patient treatment following implementation of screening digital breast tomosynthesis. Radiology 274(2):337–342. https://doi.org/10.1148/radiol.14140317 CrossRefPubMed

22.

Lång K, Nergården M, Andersson I et al (2016) False positives in breast cancer screening with one-view breast tomosynthesis: an analysis of findings leading to recall, work-up and biopsy rates in the Malmö Breast Tomosynthesis Screening Trial. Eur Radiol 26(11):3899–3907. https://doi.org/10.1007/s00330-016-4265-y CrossRefPubMedPubMedCentral

23.

Skaane P, Bandos AI, Gullien R et al (2013) Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology 267(1):47–56. https://doi.org/10.1148/radiol.12121373 CrossRefPubMed

24.

Sharpe RE, Venkataraman S, Phillips J et al (2016) Increased cancer detection rate and variations in the recall rate resulting from implementation of 3D digital breast tomosynthesis into a population-based screening program. Radiology 278(3):698–706. https://doi.org/10.1148/radiol.2015142036 CrossRefPubMed

25.

Bianchi S, Giannotti E, Vanzi E et al (2012) Radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy: Analysis of 49 cases from a single-centre and review of the literature. The Breast 21(2):159–164. https://doi.org/10.1016/j.breast.2011.09.005 CrossRefPubMed

26.

Resetkova E, Edelweiss M, Albarracin CT, Yang WT (2011) Management of radial sclerosing lesions of the breast diagnosed using percutaneous vacuum-assisted core needle biopsy: recommendations for excision based on seven years’ of experience at a single institution. Breast Cancer Res Treat 127(2):335–343. https://doi.org/10.1007/s10549-008-0119-x CrossRefPubMed

27.

Racz JM, Carter JM, Degnim AC (2017) Challenging atypical breast lesions including flat epithelial atypia, radial scar, and intraductal papilloma. Ann Surg Oncol 24(10):2842–2847. https://doi.org/10.1245/s10434-017-5980-6 CrossRefPubMed

28.

Becker L, Trop I, David J et al (2006) Management of radial scars found at percutaneous breast biopsy. Can Assoc Radiol J 57(2):72–78. http://www.ncbi.nlm.nih.gov/pubmed/16944680. Accessed July 15, 2018

Title: Rate of radial scars by core biopsy and upgrading to malignancy or high-risk lesions before and after introduction of digital breast tomosynthesis
Authors: April Phantana-angkool
Meghan R. Forster
Yancey E. Warren
Chad A. Livasy
Amy H. Sobel
Lakesha M. Beasley
Sally J. Trufan
Lejla Hadzikadic-Gusic
Terry Sarantou
Amy E. Voci
Deba Sarma
Richard L. White Jr.
Publication date: 01-01-2019
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 1/2019
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-018-4973-x

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