title: Radial scar of the breast: Is it possible to avoid surgery?
abstract: BACKGROUND
  Breast radial scar (RS) management remains controversial. The need for surgical excision is supported by the concern of an associated high-grade lesion missed in the biopsy. The aim of this study was to assess histologic upgrade rate after a percutaneous biopsy, to determine if vacuum assisted biopsy prevents the need for subsequent RS surgical resection and to evaluate the upgrade risk factors.
  
  
  METHODS
  This was a uni-institutional retrospective study of consecutive patients with RS histologically diagnosed from January 2010 to December 2015.
  
  
  RESULTS
  A total of 113 cases of RS were diagnosed. We verify that there was a histologic upgrade in 22 (19.5%) cases. The upgrade risk factors were the type of biopsy performed, the presence of atypia, the presence of calcifications and the number of fragments obtained in the biopsy (p < 0.05). The biopsy type was vacuum assisted in 25 (22.1%). The upgrade rate in the vacuum assisted biopsy group was 4.0%, whereas in the standard core needle biopsy group was 23,9% (p = 0.041).
  
  
  CONCLUSIONS
  We demonstrated that the risk of upgrade after a RS diagnosis depends on the type of biopsy performed, the presence of atypia, the presence of calcifications and the number of fragments obtained. When a standard core biopsy is performed the risk of upgrade and malignancy is not negligible, and surgery is indicated. When the biopsy is vacuum assisted, the risk of upgrade and malignancy is significantly decreased and so the indication for excisional biopsy seems not to be so imperative.
authors.affiliation: Chirurgic Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal. Electronic address: anaisabelferreira333@gmail.com.
authors.forename: A I
authors.initials: AI
authors.lastname: Ferreira
authors.affiliation: General Surgery Department, Unidade de Saúde Local de Castelo Branco, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Borges
authors.affiliation: Chirurgic Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Sousa
authors.affiliation: Chirurgic Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Ribeiro
authors.affiliation: Chirurgic Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Mesquita
authors.affiliation: Chirurgic Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal.
authors.forename: P C
authors.initials: PC
authors.lastname: Martins
authors.affiliation: Chirurgic Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Peyroteo
authors.affiliation: Pathologic Anatomy Department, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal.
authors.forename: N
authors.initials: N
authors.lastname: Coimbra
authors.affiliation: Pathologic Anatomy Department, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Leal
authors.affiliation: Chirurgic Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal.
authors.forename: P
authors.initials: P
authors.lastname: Reis
authors.affiliation: Chirurgic Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal.
authors.forename: J A
authors.initials: JA
authors.lastname: Sousa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology; D002114:Calcinosis / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014618:Vacuum; D055815:Young Adult
keywords: Complex sclerosing lesion; Histologic upgrade; Radial scar; Vacuum assisted biopsy