title: Surgical excision of radial scars diagnosed by core biopsy may help predict future risk of breast cancer.
abstract: Radial scars (RS's) are benign breast lesions known to be associated with carcinomas and other high-risk lesions (HRL's). The upgrade rate to carcinoma after core biopsy revealing RS is 0-40 %. We sought to determine the outcomes of RS with and without HRL diagnosed by core biopsy. Patients who underwent core biopsy revealing RS without carcinoma at our institution between 1/1996 and 11/2012 were identified from a surgical pathology database. Retrospective chart review was utilized to classify patients as RS-no HRL or RS-HRL. HRL was defined as ADH, LCIS, and/or ALH. We determined upgrade rate to carcinoma at surgical excision, and upgrade to HRL for RS-no HRL patients. Univariate analysis was performed to identify risk factors for upgrade in RS-no HRL patients. 156 patients underwent core biopsy revealing RS, 131 RS-no HRL (84 %), and 25 RS-HRL (16 %). The overall rate of upgrade to invasive carcinoma was 0.8 % (1/124). 1.0 % (1/102) of RS-no HRL and 13.6 % (3/22) of RS-HRL patients were upgraded to DCIS (P = 0.0023). The upgrade of RS-no HRL to HRL at excision was 21.6 % (22/102). By univariate analysis, RS-no HRL with radiologic appearance of a mass/architectural distortion had a significantly higher rate of upgrade to HRL or carcinoma compared with calcifications (P = 0.03). Excision of RS to rule out associated invasive carcinoma is not warranted, given a <1 % rate of upgrade at excision. However, excision to evaluate for non-invasive cancer or HRL may be considered to help guide clinical decision-making about use of chemoprevention.
authors.affiliation: Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Miller
authors.forename: Jane A
authors.initials: JA
authors.lastname: West
authors.forename: Anna C
authors.initials: AC
authors.lastname: Bettini
authors.forename: Frederick C
authors.initials: FC
authors.lastname: Koerner
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gudewicz
authors.forename: Phoebe E
authors.initials: PE
authors.lastname: Freer
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Coopey
authors.forename: Michele A
authors.initials: MA
authors.lastname: Gadd
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Hughes
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rafferty
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Specht
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D042361:Mammary Glands, Human / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult