Is radial scar on core needle biopsy a risk factor for malignancy? A single-center retrospective review and implications for management

Steven G Woodward; Karl Nimtz; Kim Hookim; Alexander B Sevrukov; Theodore N Tsangaris; Alliric Willis; Adam C Berger; Melissa Lazar

doi:10.1111/tbj.13975

Is radial scar on core needle biopsy a risk factor for malignancy? A single-center retrospective review and implications for management

Breast J. 2020 Oct;26(10):2011-2014. doi: 10.1111/tbj.13975. Epub 2020 Jul 13.

Authors

Steven G Woodward¹, Karl Nimtz², Kim Hookim³, Alexander B Sevrukov⁴, Theodore N Tsangaris^{1

5}, Alliric Willis¹, Adam C Berger^{1

6}, Melissa Lazar¹

Affiliations

¹ Department of Surgery, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA.
² Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA.
³ Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA.
⁴ Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA.
⁵ Cancer Center, Calvert Health, Prince Frederick, MD, USA.
⁶ Department of Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.

PMID: 32657492
DOI: 10.1111/tbj.13975

Abstract

Introduction: Reported upgrade rate to malignancy of radial scars (RS) ranges widely (0%-40%) making management controversial.

Methods: A retrospective chart review was performed on patients with RS on core needle biopsy (CNB). Upgrade rates to malignancy and atypia on surgical excision were evaluated.

Results: Of 127 patients with RS on CNB, 53 were excluded due to malignancy or missing records. Of 74 patients reviewed, 52 (70.3%) had surgical excision with four (7.7%) upgraded to malignancy. Eight patients (10.8%) had atypia with RS on CNB with two (25%) upgraded to malignancy. When isolated RS was on CNB, 2 of 44 (4.5%) upgraded to malignancy while 15 of 44 (34%) had atypia on excision. Of 22 patients (29.7%) who did not have excision, zero developed cancer.

Conclusion: We found higher than expected upgrade rates of isolated RS to atypia which can alter management. Additionally, 25% of RS with atypia upgraded to malignancy suggesting these patients are at higher risk.

Keywords: atypia; breast cancer; breast surgery; malignancy; radial scar; upgrade.

MeSH terms

Biopsy, Large-Core Needle
Breast Neoplasms* / surgery
Cicatrix* / etiology
Cicatrix* / pathology
Female
Humans
Retrospective Studies
Risk Factors