Radial Scar at Image-Guided Needle Biopsy: Is Follow-Up Excision Always Necessary?
Clare D'Arcy, Laura Liberman, Tatjana Nehhozina, Edi Brogi, Adriana Corben. Memorial Sloan Kettering Cancer Center, New York, NY
Background: The need to excise breast lesions yielding radial scar (RS) at percutaneous image-guided core biopsy (CNB) remains controversial. This study was performed to determine the rate of cancer at surgical excision (EXC) in lesions yielding RS at CNB.
Design: With IRB approval, we performed a retrospective review of CNBs with a benign diagnosis obtained at our center from 1996 to 2011. We identified 55 cases in which CNB yielded a diagnosis of RS with no other associated high risk lesion (ie, ductal or lobular atypia). Biopsy guidance was ultrasound in 27 cases, stereotactic in 20, and MRI in 8. Biopsy device was 14 gauge (G) automated needle in 25 cases, 11G vacuum-assisted probe in 20, 9G vacuum assisted probe in 7 and other in 3. Imaging and pathology findings were reviewed. The RS was considered incidental if (a) target lesion was calcification (Ca2+) and RS contained ≤10% of the Ca2+ or (b) target lesion was mass/architectural distortion (AD)/MRI enhancement, RS was ≤1/3 of the target image size and another benign lesion accounted for the imaging target. The 95% confidence intervals (CI) were calculated using Geigy scientific tables.
Results: The 55 CNBs with RS were in 56 women, median age 51 (range (R) 30-78) years. Imaging target was mass (18), Ca2+ (17), AD (9), MRI enhancement (8) and mass with Ca2+ (3). Median imaging target size was 0.8 (R 0.3-5.3) cm. RS was the imaging target in 37 (67%) and incidental in 18 (33%). Surgical excision of 52/55 (95%) lesions was performed at a median of 1 (range 0.1-78) months. Cancer was found in 4/52 (8%; 95% CI 2-19%) lesions, including 3 ductal carcinoma in situ (DCIS), and one multifocal invasive ductal carcinoma (largest focus 0.4 cm). Cancer was found at EXC in 3/16 (19%; 95% CI 4-46%) lesions evident as Ca2+, 1/3 (33%; 95% CI 1-91%) masses with Ca2+, 0/17 (0%; 95% CI 0-20%) masses, 0/9 (0%; 95% CI 0-34%) AD, and 0/7 (0%; 95% CI 0-41%) MRI enhancement lesions. Upgrade to carcinoma occurred in 4/37 (11%; 95% CI 3-25%) target vs 0/15 (0%; 95% CI 0-22%) incidental RS (p=0.3). Radiologic follow up of the 3 unexcised RS showed stability at a median of 57 (R 25-149) months.
Conclusions: Among lesions yielding RS as the highest risk lesion at CNB, surgery yielded cancer in 4/52 (8%; 95%CI 2-19%). Most cancers were DCIS and occurred in lesions evident as Ca2+. Our data support surgical excision of lesions yielding RS as the highest risk lesion at percutaneous image-guided needle biopsy.
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 19, Tuesday Morning