Risk of neoplastic transformation in asymptomatic radial scar. Analysis of 117 cases.
BACKGROUND
Radial scar (RS) is a benign breast lesion but a variable percentage of cases are associated with atypical epithelial proliferations and cancer. Previous studies have shown that patient age and the size of RS are correlated to a potential neoplastic transformation.


METHODS
We collected 117 asymptomatic patients with suspected RS following a mammogram, histologically confirmed. The clinical, pathological and immunophenotypical analysis is reported. The cases are subdivided into three different groups: (1) RS "Pure", without epithelial atypia; (2) RS associated with epithelial atypical hyperplasia; (3) RS with cancer.


RESULTS
"Pure" RS was detected in 55 patients (47%); the mean age was 48.1 years and the mean size 0.94 cm. RS associated with atypical epithelial hyperplasia was identified in 25 cases (21%) with a mean age of 53.1 years and a mean size of 0.98 cm. Carcinoma in RS was observed in 37 cases (32%); the mean age was 55.5 years and the mean size was 1.16 cm. The mean age was statistically significant (P = 0.004) in separating RS with cancer from the two other RS groups. The size of RS was not sufficiently statistically significant (P = 0.2) to differentiate the risk. Atypical lesions and cancers showed a morphology and marker of low-grade aggressiveness.


CONCLUSIONS
RS seems to represent a natural model of carcinogenesis starting from a proliferative lesion in patients of less than 50 years of age and developing into an atypical and later into a carcinomatous lesion. The fact that most carcinomas arising in RS are low grade also favors this hypothesis. All RS should be excised.
Manfrin
Erminia
E
Department of Pathology, University of Verona, Strada le Grazie 8, 37135, Verona, Italy. Erminia.Manfrin@univr.it
Remo
Andrea
A
Falsirollo
Francesca
F
Reghellin
Daniela
D
Bonetti
Franco
F
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D002471:Cell Transformation, Neoplastic; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008327:Mammography; D008875:Middle Aged