The Management of Radial Sclerosing Lesions/Radial Scars Diagnosed in Core Biopsy: Excision or Not?
Shuling Zheng, Brian O'Hea, Meenakshi Singh, Sui Zee, Carmen Tornos, Jingxuan Liu. Stony Brook University Medical Center, Stony Brook, NY
Background: Radial sclerosing lesions/radial scars (RSL/RS) are benign breast lesions that have a stellate appearance with radiating spicules mimicking breast cancer at imaging and histological levels. Though RSL/RS diagnosed by needle biopsies may lead to surgical excisions, the association of RSL/RS with breast cancer is not well-established due to conflicting data from various studies.
Design: Retrospective data were collected from women with a histological diagnosis of RSL/RS in needle core biopsies over an 11-year period from 2000 to 2011 in our institution. Patients with invasive carcinoma, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), or any type of atypia, as well as papilloma, in the same needle biopsies were excluded from this study. The histological findings of the initial biopsies and the following surgical excisions were analyzed to evaluate the necessity of open surgical excisions following a diagnosis of RSL/RS in core biopsy.
Results: 48 cases of RSL/RS on core biopsies were identified, and 34 of these 48 underwent surgical excisions. One (3%) had a small invasive ductal carcinoma in the surgical excision. None of the excision had DCIS. 4 cases showed atypia (12%) (including one atypical papilloma, one flat epithelial atypia, one with both ADH and ALH and one with ALH). The excisions in 15 of 34 cases had residual RSL/RS, and the remaining 14 cases had non-RSL/RS type benign findings on excision.
Conclusions: Surgical excisions following the diagnosis of RSL/RS on core biopsies had a very low rate of malignancy at our institution (3%). Surgical excision of RSL/RS may not be warranted in all cases.
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 32, Monday Morning