Management of radial scars/complex sclerosing lesions of the breast diagnosed by vacuum assisted large-core biopsy: Is surgery always necessary?

Julia Bacci, Gaëtan MacGrogan, Léonie Alran, Gabrielle Labrot-Hurtevent
Histopathology 2019 July 8

INTRODUCTION: Diagnosis of radial scars and complex sclerosing lesions (RS/CSL) by percutaneous biopsy carries a risk of histological underestimation. Consequently, surgical excision is often performed in order to exclude a possible associated malignancy. The aim of this study was to assess the rate of "upgrade to carcinoma" upon subsequent surgical excision of RS/CSL diagnosed by vacuum-assisted large-core biopsy (VALCB). We also analyzed the risk factors for upgrade in order to determine a subset of patients who could avoid surgery and benefit from a conservative management with clinical and imaging follow-up.

MATERIALS AND METHODS: This is a retrospective observational single-center study on 174 consecutive RS/CSL diagnosed by VALCB from May 2008 to October 2015. Univariate analysis was performed to identify clinical, radiological and histological risk factors for upgrade.

RESULTS: Surgical excision was performed following VALCB diagnosis of 88 RS/CSL with or without associated atypia. The overall rate of surgical upgrade to carcinoma was 9.1% (8/88). None of the benign biopsies without atypia were surgically upgraded. Additionally to atypia, risk factors for upgrade were non-incidental finding of the RS/CSL, mammographic appearance and number of fragments obtained during the biopsy procedure (p < 0.05).

CONCLUSION: We demonstrate that VALCB revealing RS/CSL is reliable to exclude malignancy when there is no associated atypia and when radiological and histological findings are concordant. In such cases, surgery can be avoided in favor of a clinical and imaging follow-up. When RS/CSL is associated with atypia, the decision to perform surgical excision depends on other associated risk factors. This article is protected by copyright. All rights reserved.


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