Radial scar-significant diagnostic challenge

Area of Science:

• Radiology
• Oncology
• Pathology

Background:

• Radial scars (RS) are found in 0.04% of asymptomatic women during breast cancer screening.
• Distinguishing RS from malignant lesions, such as small stellate carcinomas, is challenging due to similar radiomorphology.
• Concomitant malignancies occur in 20-30% of patients with RS.

Purpose of the Study:

• To evaluate the effectiveness of diagnostic methods in differentiating radial scars from malignancies.
• To compare mammography, physical examination, ultrasonography, and cytology in diagnosing RS and associated cancers.

Main Methods:

• Mammography diagnosed 61 cases of RS.
• Surgical excision was performed on 44 patients; histology confirmed benign or malignant lesions.
• Follow-up confirmed benign nature in 11 cases.
• Diagnostic results (mammography, physical exam, ultrasonography, cytology) were evaluated using BI-RADS scale and compared between benign (39) and malignant (16) cases.

Main Results:

• Mammography mean score was 3.49, ultrasonography 3.06, cytology 2.47, and physical examination 1.67.
• No significant difference in mammographic results or parenchymal density between benign and malignant groups.
• Significant differences observed in ultrasonographic (p=0.0176) and cytological (p<0.0001) results between groups.

Conclusions:

• Mammography detects non-palpable lesions suggestive of RS.
• Ultrasonography and cytology, particularly with ultrasound-guided fine-needle aspiration biopsy (FNAB), are more effective in differentiating benign RS from malignancy.
• This comprehensive approach clarifies the nature of suspicious lesions before surgical biopsy.