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Upgrade risk of image-targeted radial scar and complex sclerosing lesions diagnosed at needle-guided biopsy: a retrospective study

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Abstract

Objectives

To determine the upgrade rate of radial scar (RS) and complex sclerosing lesions (CSL) diagnosed with percutaneous biopsy. The secondary objectives were to determine the new atypia rate after surgery and to assess the diagnosis of subsequent malignancy on follow-up.

Methods

This single-institution retrospective study had IRB approval. All image-targeted RS and CSL diagnosed with percutaneous biopsy between 2007 and 2020 were reviewed. Patient demographics, imaging presentation, biopsy characteristics, histological report, and follow-up data were collected.

Results

During the study period, 120 RS/CSL were diagnosed in 106 women (median age, 43.5 years; range, 23–74), and 101 lesions were analyzed. At biopsy, 91 (90.1%) lesions were not associated with another atypia or malignancy and 10 (9.9%) were associated with another atypia. Out of the 91 lesions that were not associated with malignancy or atypia, 75 (82.4%) underwent surgical excision, and one upgrade to low-grade CDIS was detected (1.3%). Among the 10 lesions initially associated with another atypia, 9 were surgically excised and no malignancy was detected. After a median follow-up of 47 months (range: 12–143 months), two (1.98%) developed malignancy in a different quadrant; in both cases, another atypia was present at biopsy.

Conclusion

We found a low upgrade rate on image-detected RS/CSL, with or without another atypia associated. Associated atypia was underdiagnosed at biopsy in almost one-third of cases. Subsequent cancer risk could not be established because the only two cases were associated with another high-risk lesion (HRL), which might have increased the patient’s risk of developing malignancy.

Clinical relevance statement

Our upgrade rates of RS/CSL with or without atypia diagnosed with core needle biopsy are almost as low as the ones reported with larger sampling methods. This result has particular importance in places with limited accessibility to US-guided vacuum-assisted biopsy.

Key Points

•New evidence is showing lower upgrade rates of RS and CSL after surgery, leading to a more conservative management with extensive sampling using VAB or VAE.

•Our study showed only one upgrade to a low-grade DCIS after surgery, yielding an upgrade rate of 1.33%.

•During follow-up, no new malignancy was detected in the same quadrant where RS/CSL was diagnosed, including patients without surgery.

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Abbreviations

AD:

Architectural distortion

ADH:

Atypical ductal hyperplasia

ALH:

Atypical lobular hyperplasia

CSL:

Complex sclerosing lesion

DCIS:

Ductal carcinoma in situ

FEA:

Flat epithelial atypia

HRL:

High-risk lesion

LCIS:

Lobular carcinoma in situ

RS:

Radial scar

VAB:

Vacuum-assisted biopsy

VAE:

Vacuum-assisted excision

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Radiology Department, Clínica Alemana de Santiago, Vitacura 5951, 7630000, Santiago, RM, Chile

    Carla Darras & Marcela Uchida

Authors
  1. Carla Darras
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  2. Marcela Uchida
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Corresponding author

Correspondence to Carla Darras.

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Guarantor

The scientific guarantor of this publication is Marcela Uchida, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Gabriel Cavada kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board and Ethics Committee.

Ethical approval

Institutional Review Board and Ethics Committee approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in poster presentation at ECR EPOS 2022. Permission to permanently publish the poster was not granted.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Darras, C., Uchida, M. Upgrade risk of image-targeted radial scar and complex sclerosing lesions diagnosed at needle-guided biopsy: a retrospective study. Eur Radiol 33, 8399–8406 (2023). https://doi.org/10.1007/s00330-023-09877-6

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  • DOI: https://doi.org/10.1007/s00330-023-09877-6

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