title: Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases.
abstract: BACKGROUND
  Radial scars are benign sclerosing lesions that are routinely excised when diagnosed in a needle core biopsy. Optimal management for patients with incidental and small (≤5 mm) radial scars is uncertain.
  
  
  OBJECTIVE
  To assess pathologic upgrade of radial scars diagnosed in needle core biopsy samples and identify a subset of patients who could benefit from conservative management.
  
  
  METHODS
  Patients with a diagnosis of radial scar in a needle core biopsy who underwent excision of the biopsied area were identified. Radial scars greater than 5 mm in size and those with coexisting atypia, carcinoma, and papillary lesions were excluded. After histologic-radiographic correlation, rates of pathologic upgrade were assessed.
  
  
  RESULTS
  Seventy-seven radial scars diagnosed in 66 patients were included. Overall, 9 of 77 (12%) showed upgrade to a high-risk lesion (6 lobular carcinoma in situ, 2 atypical ductal hyperplasia, 1 atypical lobular hyperplasia), while none (0%) showed upgrade to invasive carcinoma or ductal carcinoma in situ. One of 22 incidental radial scars (4.5%) showed upgrade on excision versus 6 of 36 (16.7%) for radial scars considered to be the radiographic target (P = .23). Older age was associated with upgrade (P < .001).
  
  
  CONCLUSIONS
  No incidental or small (≤5 mm) radial scars excised revealed invasive carcinoma or ductal carcinoma in situ on excision. Provided there is good pathologic-radiologic concordance, it appears reasonable for these patients to be managed conservatively.
authors.forename: Cathleen
authors.initials: C
authors.lastname: Matrai
authors.forename: Timothy M
authors.initials: TM
authors.lastname: D'Alfonso
authors.forename: Lindsay
authors.initials: L
authors.lastname: Pharmer
authors.forename: Michele B
authors.initials: MB
authors.lastname: Drotman
authors.forename: Rache M
authors.initials: RM
authors.lastname: Simmons
authors.affiliation: From the Departments of Pathology and Laboratory Medicine (Drs Matrai, D'Alfonso, and Shin), Breast Surgery (Drs Pharmer and Simmons), and Radiology-Division of Women's Imaging (Dr Drotman), Weill Cornell Medical College, New York, New York. Drs Matrai and D'Alfonso contributed equally to this study.
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Shin
mesh_terms: D000328:Adult; D000368:Aged; D062005:Biopsy, Large-Core Needle; D001941:Breast Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D002114:Calcinosis / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology; D018275:Carcinoma, Lobular / Q000473:pathology; D002921:Cicatrix / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies