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01-06-2014 | Preclinical Study

Surgical excision of radial scars diagnosed by core biopsy may help predict future risk of breast cancer

Authors: Cynthia L. Miller, Jane A. West, Anna C. Bettini, Frederick C. Koerner, Thomas M. Gudewicz, Phoebe E. Freer, Suzanne B. Coopey, Michele A. Gadd, Kevin S. Hughes, Barbara L. Smith, Elizabeth Rafferty, Michelle C. Specht

Published in: Breast Cancer Research and Treatment | Issue 2/2014

Abstract

Radial scars (RS’s) are benign breast lesions known to be associated with carcinomas and other high-risk lesions (HRL’s). The upgrade rate to carcinoma after core biopsy revealing RS is 0–40 %. We sought to determine the outcomes of RS with and without HRL diagnosed by core biopsy. Patients who underwent core biopsy revealing RS without carcinoma at our institution between 1/1996 and 11/2012 were identified from a surgical pathology database. Retrospective chart review was utilized to classify patients as RS-no HRL or RS-HRL. HRL was defined as ADH, LCIS, and/or ALH. We determined upgrade rate to carcinoma at surgical excision, and upgrade to HRL for RS-no HRL patients. Univariate analysis was performed to identify risk factors for upgrade in RS-no HRL patients. 156 patients underwent core biopsy revealing RS, 131 RS-no HRL (84 %), and 25 RS-HRL (16 %). The overall rate of upgrade to invasive carcinoma was 0.8 % (1/124). 1.0 % (1/102) of RS-no HRL and 13.6 % (3/22) of RS-HRL patients were upgraded to DCIS (P = 0.0023). The upgrade of RS-no HRL to HRL at excision was 21.6 % (22/102). By univariate analysis, RS-no HRL with radiologic appearance of a mass/architectural distortion had a significantly higher rate of upgrade to HRL or carcinoma compared with calcifications (P = 0.03). Excision of RS to rule out associated invasive carcinoma is not warranted, given a <1 % rate of upgrade at excision. However, excision to evaluate for non-invasive cancer or HRL may be considered to help guide clinical decision-making about use of chemoprevention.

Rosen P (ed) (1997) Radial sclerosing lesions. Rosen’s breast pathology. Lippincott-Raven, Philadelphia

Douglas-Jones AG, Pace DP (1997) Pathology of R4 spiculated lesions in the breast screening programme. Histopathology 30(3):214–220PubMedCrossRef

Mitnick JS, Vazquez MF, Harris MN, Roses DF (1989) Differentiation of radial scar from scirrhous carcinoma of the breast: mammographic–pathologic correlation. Radiology 173(3):697–700PubMed

Ciatto S, Morrone D, Catarzi S, Del Turco MR, Bianchi S, Ambrogetti D, Cariddi A (1993) Radial scars of the breast: review of 38 consecutive mammographic diagnoses. Radiology 187(3):757–760PubMed

Alleva DQ, Smetherman DH, Farr Jr GH, Cederbom GJ (1999) Radial scar of the breast: radiologic–pathologic correlation in 22 cases. Radiographics 19 Spec No: S27–35; discussion S36–37

Finlay ME, Liston JE, Lunt LG, Young JR (1994) Assessment of the role of ultrasound in the differentiation of radial scars and stellate carcinomas of the breast. Clin Radiol 49(1):52–55PubMedCrossRef

Hassell P, Klein-Parker H, Worth A, Poon P (1999) Radial sclerosing lesions of the breast: mammographic and pathologic correlation. Can Assoc Radiol J 50(6):370–375PubMed

Wallis MG, Devakumar R, Hosie KB, James KA, Bishop HM (1993) Complex sclerosing lesions (radial scars) of the breast can be palpable. Clin Radiol 48(5):319–320PubMedCrossRef

Cohen MA, Sferlazza SJ (2000) Role of sonography in evaluation of radial scars of the breast. AJR Am J Roentgenol 174(4):1075–1078. doi:10.2214/ajr.174.4.1741075 PubMedCrossRef

10.

Cawson JN, Nickson C, Evans J, Kavanagh AM (2010) Variation in mammographic appearance between projections of small breast cancers compared with radial scars. J Med Imaging Radiat Oncol 54(5):415–420. doi:10.1111/j.1754-9485.2010.02194.x PubMedCrossRef

11.

Kennedy M, Masterson AV, Kerin M, Flanagan F (2003) Pathology and clinical relevance of radial scars: a review. J Clin Pathol 56(10):721–724PubMedCentralPubMedCrossRef

12.

Philpotts LE, Shaheen NA, Jain KS, Carter D, Lee CH (2000) Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology 216(3):831–837PubMedCrossRef

13.

Frouge C, Tristant H, Guinebretiere JM, Meunier M, Contesso G, Di Paola R, Blery M (1995) Mammographic lesions suggestive of radial scars: microscopic findings in 40 cases. Radiology 195(3):623–625PubMed

14.

Sloane JP, Mayers MM (1993) Carcinoma and atypical hyperplasia in radial scars and complex sclerosing lesions: importance of lesion size and patient age. Histopathology 23(3):225–231PubMedCrossRef

15.

Brenner RJ, Jackman RJ, Parker SH, Evans WP 3rd, Philpotts L, Deutch BM, Lechner MC, Lehrer D, Sylvan P, Hunt R, Adler SJ, Forcier N (2002) Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? AJR Am J Roentgenol 179(5):1179–1184. doi:10.2214/ajr.179.5.1791179 PubMedCrossRef

16.

Cawson JN, Malara F, Kavanagh A, Hill P, Balasubramanium G, Henderson M (2003) Fourteen-gauge needle core biopsy of mammographically evident radial scars: is excision necessary? Cancer 97(2):345–351. doi:10.1002/cncr.11070 PubMedCrossRef

17.

Lopez-Medina A, Cintora E, Mugica B, Opere E, Vela AC, Ibanez T (2006) Radial scars diagnosed at stereotactic core-needle biopsy: surgical biopsy findings. Eur Radiol 16(8):1803–1810. doi:10.1007/s00330-006-0196-3 PubMedCrossRef

18.

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. doi:10.1007/s10549-008-0119-x PubMedCrossRef

19.

Becker L, Trop I, David J, Latour M, Ouimet-Oliva D, Gaboury L, Lalonde L (2006) Management of radial scars found at percutaneous breast biopsy. Can Assoc Radiol J 57(2):72–78PubMed

20.

Linda A, Zuiani C, Furlan A, Londero V, Girometti R, Machin P, Bazzocchi M (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? AJR Am J Roentgenol 194(4):1146–1151. doi:10.2214/AJR.09.2326 PubMedCrossRef

21.

Londero V, Zuiani C, Linda A, Battigelli L, Brondani G, Bazzocchi M (2011) Borderline breast lesions: comparison of malignancy underestimation rates with 14-gauge core needle biopsy versus 11-gauge vacuum-assisted device. Eur Radiol 21(6):1200–1206. doi:10.1007/s00330-010-2053-7 PubMedCrossRef

22.

Douglas-Jones AG, Denson JL, Cox AC, Harries IB, Stevens G (2007) Radial scar lesions of the breast diagnosed by needle core biopsy: analysis of cases containing occult malignancy. J Clin Pathol 60(3):295–298. doi:10.1136/jcp.2006.037069 PubMedCentralPubMedCrossRef

23.

Osborn G, Wilton F, Stevens G, Vaughan-Williams E, Gower-Thomas K (2011) A review of needle core biopsy diagnosed radial scars in the Welsh Breast Screening Programme. Ann R Coll Surg Engl 93(2):123–126. doi:10.1308/003588411X12851639107953 PubMedCentralPubMedCrossRef

24.

Andacoglu O, Kanbour-Shakir A, Teh YC, Bonaventura M, Ozbek U, Anello M, Ganott M, Kelley J, Dirican A, Soran A (2013) Rationale of excisional biopsy after the diagnosis of benign radial scar on core biopsy: a single institutional outcome analysis. Am J Clin Oncol 36(1):7–11. doi:10.1097/COC.0b013e3182354a3f PubMedCrossRef

25.

Bianchi S, Giannotti E, Vanzi E, Marziali M, Abdulcadir D, Boeri C, Livi L, Orzalesi L, Sanchez LJ, Susini T, Vezzosi V, Nori J (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. Breast 21(2):159–164. doi:10.1016/j.breast.2011.09.005 PubMedCrossRef

26.

Jacobs TW, Connolly JL, Schnitt SJ (2002) Nonmalignant lesions in breast core needle biopsies: to excise or not to excise? Am J Surg Pathol 26(9):1095–1110PubMedCrossRef

27.

Ingegnoli A, d’Aloia C, Frattaruolo A, Pallavera L, Martella E, Crisi G, Zompatori M (2010) Flat epithelial atypia and atypical ductal hyperplasia: carcinoma underestimation rate. Breast J 16(1):55–59. doi:10.1111/j.1524-4741.2009.00850.x PubMedCrossRef

28.

McGhan LJ, Pockaj BA, Wasif N, Giurescu ME, McCullough AE, Gray RJ (2012) Atypical ductal hyperplasia on core biopsy: an automatic trigger for excisional biopsy? Ann Surg Oncol 19(10):3264–3269. doi:10.1245/s10434-012-2575-0 PubMedCrossRef

29.

Elsheikh TM, Silverman JF (2005) Follow-up surgical excision is indicated when breast core needle biopsies show atypical lobular hyperplasia or lobular carcinoma in situ: a correlative study of 33 patients with review of the literature. Am J Surg Pathol 29(4):534–543PubMedCrossRef

30.

Sohn V, Arthurs Z, Herbert G, Keylock J, Perry J, Eckert M, Fellabaum D, Smith D, Brown T (2007) Atypical ductal hyperplasia: improved accuracy with the 11-gauge vacuum-assisted versus the 14-gauge core biopsy needle. Ann Surg Oncol 14(9):2497–2501. doi:10.1245/s10434-007-9454-0 PubMedCrossRef

31.

Niell B, Specht M, Gerade B, Rafferty E (2012) Is excisional biopsy required after a breast core biopsy yields lobular neoplasia? AJR Am J Roentgenol 199(4):929–935. doi:10.2214/AJR.11.8447 PubMedCrossRef

32.

Nizri E, Schneebaum S, Klausner JM, Menes TS (2012) Current management practice of breast borderline lesions—need for further research and guidelines. Am J Surg 203(6):721–725. doi:10.1016/j.amjsurg.2011.06.052 PubMedCrossRef

33.

Rajan S, Wason AM, Carder PJ (2011) Conservative management of screen-detected radial scars: role of mammotome excision. J Clin Pathol 64(1):65–68. doi:10.1136/jcp.2010.083485 PubMedCrossRef

34.

Coopey SB, Mazzola E, Buckley JM, Sharko J, Belli AK, Kim EM, Polubriaginof F, Parmigiani G, Garber JE, Smith BL, Gadd MA, Specht MC, Guidi AJ, Roche CA, Hughes KS (2012) The role of chemoprevention in modifying the risk of breast cancer in women with atypical breast lesions. Breast Cancer Res Treat 136(3):627–633. doi:10.1007/s10549-012-2318-8 PubMedCrossRef

35.

Linda A, Zuiani C, Furlan A, Lorenzon M, Londero V, Girometti R, Bazzocchi M (2012) Nonsurgical management of high-risk lesions diagnosed at core needle biopsy: can malignancy be ruled out safely with breast MRI? AJR Am J Roentgenol 198(2):272–280. doi:10.2214/AJR.11.7040 PubMedCrossRef

36.

Perfetto F, Fiorentino F, Urbano F, Silecchia R (2009) Adjunctive diagnostic value of MRI in the breast radial scar. Radiol Med (Torino) 114(5):757–770. doi:10.1007/s11547-009-0405-7 CrossRef

37.

Cawson JN (2005) Can sonography be used to help differentiate between radial scars and breast cancers? Breast 14(5):352–359. doi:10.1016/j.breast.2005.01.003 PubMedCrossRef

38.

Jacobs TW, Byrne C, Colditz G, Connolly JL, Schnitt SJ (1999) Radial scars in benign breast-biopsy specimens and the risk of breast cancer. N Engl J Med 340(6):430–436. doi:10.1056/NEJM199902113400604 PubMedCrossRef

39.

Sanders ME, Page DL, Simpson JF, Schuyler PA, Dale Plummer W, Dupont WD (2006) Interdependence of radial scar and proliferative disease with respect to invasive breast carcinoma risk in patients with benign breast biopsies. Cancer 106(7):1453–1461. doi:10.1002/cncr.21730 PubMedCrossRef

40.

Berg JC, Visscher DW, Vierkant RA, Pankratz VS, Maloney SD, Lewis JT, Frost MH, Ghosh K, Degnim AC, Brandt KR, Vachon CM, Reynolds CA, Hartmann LC (2008) Breast cancer risk in women with radial scars in benign breast biopsies. Breast Cancer Res Treat 108(2):167–174. doi:10.1007/s10549-007-9605-9 PubMedCrossRef

41.

Manfrin E, Remo A, Falsirollo F, Reghellin D, Bonetti F (2008) Risk of neoplastic transformation in asymptomatic radial scar. Analysis of 117 cases. Breast Cancer Res Treat 107(3):371–377. doi:10.1007/s10549-007-9569-9 PubMedCrossRef

42.

Bunting DM, Steel JR, Holgate CS, Watkins RM (2011) Long term follow-up and risk of breast cancer after a radial scar or complex sclerosing lesion has been identified in a benign open breast biopsy. Eur J Surg Oncol 37(8):709–713. doi:10.1016/j.ejso.2011.04.011 PubMedCrossRef

43.

Aroner SA, Collins LC, Connolly JL, Colditz GA, Schnitt SJ, Rosner BA, Hankinson SE, Tamimi RM (2013) Radial scars and subsequent breast cancer risk: results from the Nurses’ Health Studies. Breast Cancer Res Treat 139(1):277–285. doi:10.1007/s10549-013-2535-9 PubMedCentralPubMedCrossRef

44.

Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, Vogel V, Robidoux A, Dimitrov N, Atkins J, Daly M, Wieand S, Tan-Chiu E, Ford L, Wolmark N (1998) Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 90(18):1371–1388PubMedCrossRef

45.

Cummings SR, Eckert S, Krueger KA, Grady D, Powles TJ, Cauley JA, Norton L, Nickelsen T, Bjarnason NH, Morrow M, Lippman ME, Black D, Glusman JE, Costa A, Jordan VC (1999) The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple outcomes of raloxifene evaluation. JAMA 281(23):2189–2197PubMedCrossRef

46.

Vogel VG, Costantino JP, Wickerham DL, McCaskill-Stevens W, Clarfeld RB, Grant MD, Wolmark N (2010) Carcinoma in situ outcomes in National Surgical Adjuvant Breast and Bowel Project Breast Cancer Chemoprevention Trials. J Natl Cancer Inst Monogr 2010(41):181–186. doi:10.1093/jncimonographs/lgq041 PubMedCrossRef

47.

Ropka ME, Keim J, Philbrick JT (2010) Patient decisions about breast cancer chemoprevention: a systematic review and meta-analysis. J Clin Oncol 28(18):3090–3095. doi:10.1200/JCO.2009.27.8077 PubMedCentralPubMedCrossRef

Title: Surgical excision of radial scars diagnosed by core biopsy may help predict future risk of breast cancer
Authors: Cynthia L. Miller
Jane A. West
Anna C. Bettini
Frederick C. Koerner
Thomas M. Gudewicz
Phoebe E. Freer
Suzanne B. Coopey
Michele A. Gadd
Kevin S. Hughes
Barbara L. Smith
Elizabeth Rafferty
Michelle C. Specht
Publication date: 01-06-2014
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 2/2014
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-014-2958-y

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