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Risk of malignancy when microscopic radial scars and microscopic papillomas are found at percutaneous biopsy
Karen A Lee1, Margarita L Zuley, Mamatha Chivukula
1Breast Imaging, Department of Radiology, Magee-Women's Hospital of the University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15213, USA.
Objective:
The objective of our study was to assess the incidence of associated malignancy when microscopic radial scars and microscopic intraductal papillomas are encountered at percutaneous biopsy for lesions that otherwise reveal benign histopathology.
Materials And Methods:
A search of the pathology database for the period from December 14, 2006, through December 21, 2009, identified patients with a microscopic radial scar, a microscopic intraductal papilloma, or both at percutaneous biopsy. Patients whose percutaneous biopsy was performed for a lesion that revealed carcinoma or a high-risk pathology result were excluded to avoid confounding bias, as were patients who had only imaging follow-up. Only patients who underwent surgery solely for the study lesion were included. The lesion type that prompted core biopsy, biopsy guidance and device, sample number, and surgical outcomes were recorded. The incidences of benign, high-risk, and malignant pathology findings from surgery were calculated.
Results:
The search revealed 35 patients (18 microscopic radial scars, 17 microscopic papillomas) who underwent surgery solely for the study lesion. Stereotactic guidance was used for 15 (43%); ultrasound, for 12 (34%); and MRI, for eight (23%). At surgery, 12 patients (34%) had high-risk histopathology results and 23 (66%) had benign results. No study lesions were upgraded to malignancy.
Conclusion:
Our study found no evidence of associated malignancy at surgical excision when microscopic radial scars and microscopic intraductal papillomas were encountered at percutaneous biopsy in patients who otherwise had benign histopathology results; thus, routine imaging follow-up may be performed.
Insights
Microscopic radial scars and intraductal papillomas found on percutaneous biopsy do not indicate associated malignancy. These benign findings suggest routine imaging follow-up may be sufficient, avoiding unnecessary surgical intervention.
Area of Science:
- Radiology
- Pathology
- Breast Imaging
Background:
- Microscopic radial scars and intraductal papillomas are benign findings on breast biopsies.
- Distinguishing between benign and malignant lesions is crucial for patient management.
Purpose of the Study:
- To determine the incidence of associated malignancy in lesions with microscopic radial scars or intraductal papillomas.
- To evaluate if these findings warrant surgical excision or if routine imaging follow-up is adequate.
Main Methods:
- A retrospective review of a pathology database identified patients with microscopic radial scars or intraductal papillomas.
- Patients with pre-existing carcinoma or high-risk pathology were excluded.
- Only patients who underwent surgery solely for the study lesion were included in the analysis.
Main Results:
- 35 patients (18 with radial scars, 17 with papillomas) underwent surgery.
- No study lesions were upgraded to malignancy.
- 34% of patients had high-risk histopathology, and 66% had benign results at surgery.
Conclusions:
- Microscopic radial scars and intraductal papillomas on percutaneous biopsy, with otherwise benign pathology, are not associated with malignancy.
- Routine imaging follow-up may be appropriate for these findings.
- Surgical excision may not be necessary solely for these specific benign findings.
