title: Radial scars diagnosed on breast core biopsy: Frequency of atypia and carcinoma on excision and implications for management.
abstract: OBJECTIVE
  The risk of finding carcinoma in excisions following a core needle biopsy diagnosis of radial scar is not well defined and clinical management is variable. The aim of this study is to determine the frequency of high-risk lesions, ductal carcinoma in situ, and invasive carcinoma in excisions following a core biopsy diagnosis of radial scar.
  
  
  RESULTS
  Dedicated breast pathologists and radiologists correlated the histologic and radiologic findings and categorized radial scars as the target lesion or an incidental finding. High-risk lesions were defined as atypical hyperplasia or classical lobular carcinoma in situ. Of the 79 radial scars identified over a 14-year period, 22 were associated with atypia or carcinoma in the core biopsy. Thirty-seven (37) of the 57 benign radial scars underwent excision with benign findings in 30 (81%), high-risk lesions in six (16%), and flat epithelial atypia in one (3%). There were no upgrades to carcinoma. One patient with a benign radial scar developed a 3-mm focus of intermediate-grade estrogen receptor-positive ductal carcinoma in situ in the same quadrant of the ipsilateral breast 72 months after excision. One patient with an incidental un-excised benign radial scar was diagnosed with ductal carcinoma in situ at a separate site of suspicious calcifications.
  
  
  CONCLUSIONS
  In this series, none of the benign radial scars was upgraded to carcinoma. Radial scar was the targeted lesion in all cases with high-risk lesions on excision. Surgical excision may not be mandatory for patients with benign incidental radial scars on core biopsy.
authors.affiliation: Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA. Electronic address: donalda@ccf.org.
authors.forename: Alana R
authors.initials: AR
authors.lastname: Donaldson
authors.affiliation: Imaging Institute, Department of Breast Imaging, Cleveland Clinic, Cleveland, OH, USA. Electronic address: sieckl@ccf.org.
authors.forename: Leah
authors.initials: L
authors.lastname: Sieck
authors.affiliation: Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA. Electronic address: boothc1@ccf.org.
authors.forename: Christine N
authors.initials: CN
authors.lastname: Booth
authors.affiliation: Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA. Electronic address: calhoub@ccf.org.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Calhoun
mesh_terms: D000328:Adult; D000368:Aged; D062005:Biopsy, Large-Core Needle; D001940:Breast / Q000000981:diagnostic imaging / Q000473:pathology*; D000071960:Breast Carcinoma In Situ / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D012189:Retrospective Studies; D012598:Sclerosis; D016217:Ultrasonography, Mammary
keywords: Breast; Core biopsy; Diagnosis; Pathology; Radial scar; Screening