[209] Significance of Radial Scar Diagnosis in Breast Core Biopsy and Correlation with Follow up Surgical Excision

A Kanbour-Shakir, YC Teh, M Bonaventura, A Soran. Magee-Womens Hospital of UPMC Health System, Pittsburgh, PA

Background: Radial scar (RS) is a benign breast lesion composed of fibrous central core surrounded by radiating ducts/lobules with varying degree of epithelial hyperplasia and adenosis. Current literature suggests that the presence of RS on core biopsy of a mammographic suspicious lesion are often associated with invasive/noninvasive breast cancer on excisional biopsy. Also women with radial scars had a risk of breast cancer almost twice that of women without the scars. This is a retrospective review of RS found in breast core biopsy specimens, associated histopathologic changes and the correlation with the histopathologic changes of the follow up surgical excision.
Design: Computer search of all breast core biopsies over the past five years (2003-2007) at Magee-Womens Hospital with the diagnosis of radial scar were evaluated. The histopathologic changes including the presence of associated cancer (invasive carcinoma and in situ) and/or high risk lesions (HRL): atypical ductal hyperplasia {ADH}; lobular carcinoma in situ {LCIS}/atypical lobular hyperplasia {ALH}; and papillomas; associated microcalcifications; and benign lesions (fibroadenoma {FA}, sclerosing adenosis {SA}, ductal hyperplasia {DH}, columnar cell changes {CCC}, or pseudoangiomatous stromal hyperplasia {PASH}), were tabulated and correlated with those of the follow-up surgical excision.
Results: A total of 195 out of 13,424 (1.45%) breast core biopsy specimens during 5 years period had RS diagnosis. Of those 153 (78.5%) had associated microcalcifications. 90/195 (46%) had RS and associated cancer and/or HRL.

RS associated pathologic findings in 195 core biopsies

Total	Benign	Cancer (invasive/in situ)	ADH	LCIS/ALH	Papilloma
Core biopsies (195)	105	18	30	11	31

These findings mandated surgical excision. Of the remaining 105, 72 (68.6%) had associated microcalcifications. Only 53/105 (50.5%) had follow up surgical excision with the following pathologic findings: 19 (36%) had cancer and/or HRL (6 cancers, 9 ADH and 4 LCIS/ALH). The other 34 had benign lesions.
Conclusions: 46% of breast core biopsies with RS had associated cancer or high risk lesions (HRL) mandating surgical excision. 36% of breast core biopsies with RS and benign lesions had cancer or HRL on follow-up surgical excision. The high incidence of atypia and malignancy identified in this group of patients justify the surgical removal of all RS cases diagnosed on core biopsy.
Category: Breast

Tuesday, March 10, 2009 1:00 PM

Poster Session IV # 8, Tuesday Afternoon