[264] Upgrade Rates on Surgical Excision for Targeted vs. Incidental Radial Scars/Complex Sclerosing Lesions (RS/CSLs) Identified on Core Needle Biopsy (CNB)

Melina Shabani, Tejas S Mehta, Catherine Wells, James A Kraus, Hannah Gilmore, Stuart J Schnitt, Laura C Collins. Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Massachusetts General Hospital, Boston, MA; Case Western Reserve University, Cleveland, OH

Background: Prior studies have suggested that a histologic diagnosis of RS/CSL warrants surgical excision because of its association with malignancy. Recent advances in imaging techniques and larger tissue sampling have resulted in increasing diagnoses of incidental RSs. While many studies have looked at upgrade rates on excision for RS/CSLs diagnosed on CNB, to our knowledge none have specifically compared upgrade rates in targeted versus incidental RS/CSLs.
Design: We retrospectively searched breast pathology tissue diagnoses and identified 74 cases of RS/CSLs reported on CNB over a 5-year period (2004-2009). Only those cases without associated atypia or carcinoma on CNB were included. A breast pathologist reviewed each case to confirm the diagnosis. Blinded to excision diagnoses, radiologic-pathologic correlation was performed to ascertain whether the RS/CSL on CNB was the target lesion or an incidental finding. Upgrade rates on excision were then determined for both groups.
Results: Of the 74 cases, 11 were excluded after initial pathology review (5 due to atypia and 6 with no RS/CSL). Twenty-four lesions were reclassified as sclerosing and/or intraductal papillary lesions, and 12 did not undergo excision, leaving a total of 27 cases with RS/CSLs on CNB and follow-up surgical excision. 21 RS/CSLs were targeted, and 6 were incidental to other targeted lesions (e.g. fibroadenoma, duct ectasia). Of the 21 targeted RS/CSLs, 6 (29%) were upgraded on excision (all atypical hyperplasias unassociated with the RS/CSL). Of note, among the 6 incidental RS/CSLs 3 (50%) were upgraded to atypical hyperplasia on excision.

Outcome of Targeted vs. Incidental RS/CSLs
RS/CSLs: 39
27 Excised
21 Targeted6 Incidental
6 Upgraded (6 atypical hyperplasias)3 Upgraded (3 atypical hyperplasias)
Upgrade Rate: 29%Upgrade Rate: 50%

Conclusions: The upgrade rate for targeted radiologically concordant RS/CSLs remains unacceptably high to consider surveillance over excision. Even incidental RSs were associated with a high upgrade rate, though the sample size in this subset was small. Of note, however, none of the upgrades included DCIS or invasive carcinoma, and all of the atypical hyperplasias were remote from the RS/CSL in the excisions. Larger studies are still required before definitive recommendations can be made; currently, we continue to excise all radial scars diagnosed on core needle biopsy at our institution.
Category: Breast

Monday, March 19, 2012 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 43, Monday Morning


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