Complex sclerosing lesion: the lesion is complex, the management is straightforward

Area of Science:

• Radiology
• Pathology
• Breast Imaging

Background:

• Complex sclerosing lesions (CSL) and radial scars (RS) are common breast pathologies.
• These lesions are often asymptomatic and detected incidentally or via mammographic screening.
• CSL and RS can present mammographic features similar to malignancy, complicating diagnosis and management.

Purpose of the Study:

• To review cases of CSL detected during mammographic screening.
• To compare the mammographic and sonographic features of CSL/RS with those of spiculated carcinomas.
• To evaluate the diagnostic accuracy of imaging modalities and fine-needle aspiration biopsy for CSL/RS.

Main Methods:

• Retrospective review of 23 CSL cases detected during screening mammography.
• Comparison with 126 spiculated carcinomas from the same screening period.
• Assessment included radiological, clinical, and cytological work-up prior to surgical biopsy.

Main Results:

• CSL/RS showed varied presentations, including lucent centers or central masses, with spicule lengths ranging from 25-90 mm.
• No CSL/RS contained suspicious calcifications, unlike spiculated carcinomas (17% had suspicious microcalcifications).
• Provisional radiological diagnosis correctly identified CSL/RS in 78% of cases, with 17% misdiagnosed as carcinoma.

Conclusions:

• Mammographic and sonographic differentiation between RS/CSL and stellate-type carcinoma is not definitive.
• For screen-detected lesions suspected to be RS/CSL, surgical biopsy with appropriate localization is necessary.
• Optimal surgical management involves a small, adequate biopsy with consideration for cosmetic incision.