Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution

Area of Science:

• Radiology and Pathology
• Breast Imaging
• Oncology

Background:

• Radial scars (RSs) and complex sclerosing lesions (CSLs) are benign breast entities.
• Their incidence has increased with screening programs, posing diagnostic challenges due to mimicry of carcinoma.
• These lesions are often detected via core needle biopsy (CNB).

Purpose of the Study:

• To evaluate the diagnostic accuracy and clinical significance of radial scars/complex sclerosing lesions diagnosed on core needle biopsy.
• To determine the rate of upstaging to atypia or malignancy following excisional biopsy.
• To identify factors predicting the need for follow-up excisional biopsy.

Main Methods:

• Retrospective review of 100 image-guided CNBs diagnosing RS/CSL without atypia from 1994-2013.
• Assessment of pathology reports from subsequent excisional biopsies.
• Analysis of radiologic and pathologic concordance and upstaging rates.

Main Results:

• Of 100 CNBs, 38% (35 women) had follow-up excision. Median size was 1.2 cm; 69% were >1.0 cm.
• Radiologic and pathologic concordance was high (92%). 79% were BI-RADS level 4 (suspicious).
• Eleven excisional biopsies (29%) were upstaged to carcinoma (in situ or invasive) or atypical hyperplasia.

Conclusions:

• Follow-up excisional biopsy is warranted for RS/CSLs, particularly those >1.0 cm, with concerning imaging, or discordant findings.
• Nearly 29% of RS/CSLs are upstaged, highlighting the importance of complete excision for accurate diagnosis and management.
• These findings underscore the need for careful evaluation of RS/CSLs to exclude malignancy.