Advertisement

Breast Cancer Research and Treatment

, Volume 173, Issue 1, pp 23–29 | Cite as

Rate of radial scars by core biopsy and upgrading to malignancy or high-risk lesions before and after introduction of digital breast tomosynthesis

  • April Phantana-angkool
  • Meghan R. Forster
  • Yancey E. Warren
  • Chad A. Livasy
  • Amy H. Sobel
  • Lakesha M. Beasley
  • Sally J. Trufan
  • Lejla Hadzikadic-Gusic
  • Terry Sarantou
  • Amy E. Voci
  • Deba Sarma
  • Richard L. WhiteJr.Email author
Review

Abstract

Purpose

Radial scars (RS) commonly present mammographically as architectural distortions, but these lesions may be associated with non-invasive and invasive breast cancer. Digital breast tomosynthesis (DBT) has resulted in higher detection rates of architectural distortion particularly in patients with dense breast tissue. We hypothesized that rates of clinically relevant lesions confirmed surgically would be lower in patients who received DBT imaging compared with those who received standard digital breast imaging.

Methods

We performed a retrospective review of 223 patients diagnosed with pure RS by core biopsy and surgical excision before and after DBT was introduced. The rate of upgrading to malignancy or high-risk lesion was evaluated. Demographics, biopsy type, and histologic data were analyzed. Univariable logistic regression analysis was used to identify variables that may be associated with upgrading.

Results

The rate of identifying RS increased from 0.04–.13% (P < 0.0001) with DBT imaging. The upgrade rate on surgical specimen to invasive or non-invasive cancer was similar before and after DBT; 6% versus 3%, as were findings of a high-risk lesion; 12% versus 22%. No predictive factors were identified for patients upgraded to malignant neoplasms or high-risk lesions.

Conclusions

The likelihood of identifying RS has increased with DBT imaging, but rates of upgrading to a malignant neoplasm or high-risk lesion were similar to those before DBT. Although the rate of upgrading to malignancy after DBT was low, an excisional biopsy should be considered as 22% of patients were upgraded to high-risk lesions. These patients are candidates for chemoprevention and/or high-risk surveillance.

Keywords

Radial scar Breast cancer Core biopsy Excisional biopsy Upgrade Digital breast tomosynthesis 

Notes

Acknowledgements

We thank Geraldine M Chadwick, AuD, who provided medical writing support on behalf of the Department of Surgery, Carolinas Medical Center.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study has received ethical approval by the Carolinas HealthCare System Institutional Review Board as it satisfies requirements of 45 CFR 46 110, category #5.

Informed consent

This was a retrospective study. For this type of study, formal consent was not required by the IRB.

References

  1. 1.
    Schnitt S, Collins L (2017) Biopsy interpretation of the breast. vol 63. 3rd edn. (Epstein J (ed)). Boston: LWW; 2017Google Scholar
  2. 2.
    Tabar L, Dean P (2012) Teaching atlas of mammography, 4th edn. Thieme, New YorkGoogle Scholar
  3. 3.
    Orel SG, Evers K, Yeh IT, Troupin RH (1992) Radial scar with microcalcifications: radiologic-pathologic correlation. Radiology 183(2):479–482.  https://doi.org/10.1148/radiology.183.2.1561353 Google Scholar
  4. 4.
    Gaur S, Dialani V, Slanetz PJ, Eisenberg RL (2013) Architectural distortion of the breast. Am J Roentgenol 201(5):662–670.  https://doi.org/10.2214/AJR.12.10153 Google Scholar
  5. 5.
    Jackman RJ, Nowels KW, Rodriguez-Soto J, Marzoni FA, Finkelstein SI, Shepard MJ (1999) Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up. Radiology 210(3):799–805.  https://doi.org/10.1148/radiology.210.3.r99mr19799 Google Scholar
  6. 6.
    Philpotts LE, Shaheen NA, Jain KS et al (2000) Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology 216(3):831–837.  https://doi.org/10.1148/radiology.216.3.r00se31831 Google Scholar
  7. 7.
    Linda A, Zuiani C, Furlan A et al (2010) Radial scars without atypia diagnosed at imaging-guided needle biopsy: how often is associated malignancy found at subsequent surgical excision, and do mammography and sonography predict which lesions are malignant? Am J Roentgenol 194(4):1146–1151.  https://doi.org/10.2214/AJR.09.2326 Google Scholar
  8. 8.
    Brenner RJ, Jackman RJ, Parker SH et al (2002) Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? Am J Roentgenol 179(5):1179–1184.  https://doi.org/10.2214/ajr.179.5.1791179 Google Scholar
  9. 9.
    Miller CL, West JA, Bettini AC et al (2014) Surgical excision of radial scars diagnosed by core biopsy may help predict future risk of breast cancer. Br Cancer Res Treat 145(2):331–338.  https://doi.org/10.1007/s10549-014-2958-y Google Scholar
  10. 10.
    Conlon N, D’Arcy C, Kaplan JB et al (2015) Radial scar at image-guided needle biopsy: is excision necessary? Am J Surg Pathol 39(6):779–785.  https://doi.org/10.1097/PAS.0000000000000393 Google Scholar
  11. 11.
    Matrai C, D’alfonso TM, Pharmer L et al (2015) Advocating nonsurgical management of patients with small, incidental radial scars at the time of needle core biopsy A Study of 77 cases. Arch Pathol Lab Med 139(9):1137–1142.  https://doi.org/10.5858/arpa.2014-0550-OA Google Scholar
  12. 12.
    Kim EMH, Hankins A, Cassity J et al (2016) Isolated radial scar diagnosis by core-needle biopsy: is surgical excision necessary? Springerplus 5(1):398.  https://doi.org/10.1186/s40064-016-1993-z Google Scholar
  13. 13.
    Li Z, Ranade A, Zhao C (2016) Pathologic findings of follow-up surgical excision for radial scar on breast core needle biopsy. Hum Pathol 48:76–80.  https://doi.org/10.1016/j.humpath.2015.06.028 Google Scholar
  14. 14.
    Chou WYY, Veis DJ, Aft R (2018) Radial scar on image-guided breast biopsy: is surgical excision necessary? Breast Cancer Res Treat 170(2):313–320.  https://doi.org/10.1007/s10549-018-4741-y Google Scholar
  15. 15.
    López-Medina A, Cintora E, Múgica B et al (2006) Radial scars diagnosed at stereotactic core-needle biopsy: surgical biopsy findings. Eur Radiol 16(8):1803–1810.  https://doi.org/10.1007/s00330-006-0196-3 Google Scholar
  16. 16.
    Miller CL, West JA, Bettini AC et al (2014) Surgical excision of radial scars diagnosed by core biopsy may help predict future risk of breast cancer. Breast Cancer Res Treat 145(2):331–338.  https://doi.org/10.1007/s10549-014-2958-y Google Scholar
  17. 17.
    Andacoglu O, Kanbour-Shakir A, Teh YC et al (2013) Rationale of excisional biopsy after the diagnosis of benign radial scar on core biopsy: a single institutional outcome analysis. Am J Clin Oncol Cancer Clin Trials 36(1):7–11.  https://doi.org/10.1097/COC.0b013e3182354a3f Google Scholar
  18. 18.
    Noroozian M, Hadjiiski L, Rahnama-Moghadam S et al (2012) Digital breast tomosynthesis is comparable to mammographic spot views for mass characterization. Radiology 262(1):61–68.  https://doi.org/10.1148/radiol.11101763 Google Scholar
  19. 19.
    Zuley ML, Bandos AI, Ganott MA et al (2013) Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions. Radiology 266(1):89–95.  https://doi.org/10.1148/radiol.12120552 Google Scholar
  20. 20.
    Hooley RJ, Durand MA, Philpotts LE (2017) Advances in digital breast tomosynthesis. Am J Roentgenol 208(2):256–266.  https://doi.org/10.2214/AJR.16.17127 Google Scholar
  21. 21.
    Lourenco AP, Barry-Brooks M, Baird G et al (2015) Changes in recall type and patient treatment following implementation of screening digital breast tomosynthesis. Radiology 274(2):337–342.  https://doi.org/10.1148/radiol.14140317 Google Scholar
  22. 22.
    Lång K, Nergården M, Andersson I et al (2016) False positives in breast cancer screening with one-view breast tomosynthesis: an analysis of findings leading to recall, work-up and biopsy rates in the Malmö Breast Tomosynthesis Screening Trial. Eur Radiol 26(11):3899–3907.  https://doi.org/10.1007/s00330-016-4265-y Google Scholar
  23. 23.
    Skaane P, Bandos AI, Gullien R et al (2013) Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology 267(1):47–56.  https://doi.org/10.1148/radiol.12121373 Google Scholar
  24. 24.
    Sharpe RE, Venkataraman S, Phillips J et al (2016) Increased cancer detection rate and variations in the recall rate resulting from implementation of 3D digital breast tomosynthesis into a population-based screening program. Radiology 278(3):698–706.  https://doi.org/10.1148/radiol.2015142036 Google Scholar
  25. 25.
    Bianchi S, Giannotti E, Vanzi E et al (2012) Radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy: Analysis of 49 cases from a single-centre and review of the literature. The Breast 21(2):159–164.  https://doi.org/10.1016/j.breast.2011.09.005 Google Scholar
  26. 26.
    Resetkova E, Edelweiss M, Albarracin CT, Yang WT (2011) Management of radial sclerosing lesions of the breast diagnosed using percutaneous vacuum-assisted core needle biopsy: recommendations for excision based on seven years’ of experience at a single institution. Breast Cancer Res Treat 127(2):335–343.  https://doi.org/10.1007/s10549-008-0119-x Google Scholar
  27. 27.
    Racz JM, Carter JM, Degnim AC (2017) Challenging atypical breast lesions including flat epithelial atypia, radial scar, and intraductal papilloma. Ann Surg Oncol 24(10):2842–2847.  https://doi.org/10.1245/s10434-017-5980-6 Google Scholar
  28. 28.
    Becker L, Trop I, David J et al (2006) Management of radial scars found at percutaneous breast biopsy. Can Assoc Radiol J 57(2):72–78. http://www.ncbi.nlm.nih.gov/pubmed/16944680. Accessed July 15, 2018

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • April Phantana-angkool
    • 1
  • Meghan R. Forster
    • 1
  • Yancey E. Warren
    • 1
  • Chad A. Livasy
    • 2
  • Amy H. Sobel
    • 3
  • Lakesha M. Beasley
    • 1
  • Sally J. Trufan
    • 4
  • Lejla Hadzikadic-Gusic
    • 1
  • Terry Sarantou
    • 1
  • Amy E. Voci
    • 1
  • Deba Sarma
    • 1
  • Richard L. WhiteJr.
    • 1
    • 5
    Email author
  1. 1.Division of Surgical Oncology, Department of Surgery, Levine Cancer InstituteCarolinas Medical CenterCharlotteUSA
  2. 2.Charlotte Pathology GroupCharlotteUSA
  3. 3.Charlotte RadiologyCharlotteUSA
  4. 4.Department of Cancer BiostatisticsLevine Cancer InstituteCharlotteUSA
  5. 5.Division of Surgical Oncology, Department of Surgery, Levine Cancer InstituteCarolinas Medical CenterCharlotteUSA

Personalised recommendations