title: Isolated radial scar diagnosis by core-needle biopsy: Is surgical excision necessary?
abstract: OBJECTIVE
  Radial scar and radial sclerosis (RS) are considered benign breast lesions with proliferative features. There is sparse literature on frequency of cancer upgrade in these patients without atypical features found on image-guided needle biopsy. This study retrospectively reviews cases of isolated RS diagnosed on needle biopsy and evaluates the cancer upgrade after subsequent surgical excision.
  
  
  METHODS
  We conducted a retrospective cross-sectional study of cases with an isolated RS diagnosis based on needle biopsy and subsequent surgical pathology among all patients between January 1, 2009 and December 31, 2013. Patients with concomitant atypia, lobular carcinoma in situ on core biopsy, complete excision of very small RS with needle biopsy, and radiology-pathology discordance were excluded. An upgrade from the needle biopsy of RS was defined as surgical excision pathology that revealed ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), and/or invasive lobular carcinoma (ILC).
  
  
  RESULTS
  10,921 image-guided needle biopsy pathology reports were collected and 88 patients (0.81 %) were identified as having isolated RS. Of these 88 patients, 63 (72 %) underwent excision. The upgrade rate to cancer on subsequent surgical excision was 1.59 % (1/63) for DCIS; 0 % (0/63) for IDC; and 0 % (0/63) ILC. Twenty-five patients who did not undergo surgical excision had stable imaging studies with mean (±SD) 26 (±20) months follow up.
  
  
  CONCLUSIONS
  Isolated radial scar on needle biopsy may not warrant routine surgical excision given relatively low cancer upgrade rates. Advancement in breast imaging, pathology and multidisciplinary approaches to care may effectively guide non-surgical management of RS.
authors.affiliation: Sutter Medical Group, Sacramento, CA USA ; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA ; Sutter Institute for Medical Research, Sacramento, CA USA.
authors.forename: Elizabeth Min Hui
authors.initials: EM
authors.lastname: Kim
authors.affiliation: Sutter Institute for Medical Research, Sacramento, CA USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Hankins
authors.affiliation: Diagnostic Pathology Medical Group, Sacramento, CA USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Cassity
authors.affiliation: Sutter Medical Group, Sacramento, CA USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: McDonald
authors.affiliation: Sutter Medical Group, Sacramento, CA USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: White
authors.affiliation: Diagnostic Pathology Medical Group, Sacramento, CA USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Rowberry
authors.affiliation: Sutter Medical Group, Sacramento, CA USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Dutton
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA ; Johns Hopkins University School of Medicine, Baltimore, MD USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Snyder
keywords: Benign breast disease; Breast cancer; Radial scar; Radial sclerosis; Surgical management