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Percutaneous Core Needle Biopsy of Radial Scars of the Breast: When Is Excision Necessary?

¹ Tower—St. John's Imaging, Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute, St. John's Hospital and Health Center, 1328 22nd St., Santa Monica, CA 90404.
² Department of Radiology, UCLA School of Medicine, 200 UCLA Medical Plaza, Rm. 165-47, Los Angeles, CA 90095-1721.
³ Department of Diagnostic Radiology, Palo Alto Medical Clinic, 795 El Camino Real, Palo Alto, CA 94301.
⁴ Sally Jobe Breast Center, Radiology Imaging Associates, 1001 E. Layton Ave., Englewood, CO 90110-7017.
⁵ Susan G. Komen Breast Center, 3535 Worth St., Ste. 340, Dallas, TX 75246.
⁶ Department of Radiology, Yale University, 333 Cedar St., New Haven, CT 06520-8042.
⁷ Jacqueline M. Wilentz Comprehensive Breast Center, Monmouth Medical Center, 300 Second Ave., Long Branch, NJ 07740.
⁸ Department of Radiology, Jane Brattain Breast Center, Park Nicollet Medical Center, 3900 Park Nicollet Blvd., St. Louis Park, MN 55416.
⁹ CERIM, Instutucion De Avanzada, Pionera en el Diagnstico, De Las Enfermedades Mamarias, Azcuenaga 970, (1115) Buenos Aires, Argentina.
¹⁰ La Jolla Radiology, Ste. B, 7301 Girard Ave., La Jolla, CA 92037.
¹¹ Health Science Center-Breast Division, University of Arizona Medical Center, 1501 N. Campbell Ave., Tucson, AZ 85724.
¹² Mammography Section, Virginia Mason Medical Center, 1100 Ninth Ave. C5-XR, Seattle, WA 98111.
¹³ Mission Breast Center, c/o 456 28241 Crown Valley Pkwy., Ste. F, Laguna Niguel, CA 92677.

OBJECTIVE. This study was conducted to evaluate the outcome of cases of radial scar diagnosed by percutaneous core needle biopsy.

MATERIALS AND METHODS. Of 198 nonpalpable lesions diagnosed with radial scars found at core needle biopsy, 157 lesions constituting the study group had undergone surgical excision (n = 102) or mammographic surveillance after biopsy for at least 24 months (median, 38 months; n = 55). Mammographic lesion type, lesion size, biopsy guidance method, biopsy device, number of specimens per lesion, and presence of atypical hyperplasia at percutaneous biopsy were retrospectively analyzed. Results were compared with histologic findings at surgery or mammographic findings during surveillance.

RESULTS. Carcinoma was found at excision in 28% (8/29) of lesions with associated atypical hyperplasia at percutaneous biopsy and 4% (5/128) of lesions without associated atypia (p < 0.0001). In the latter group, carcinoma was found at excision in 3% (2/60) of masses, 8% (3/40) of architectural distortions, and 0% (0/28) of microcalcification lesions. Malignancy was missed in 9% (5/58) of lesions biopsied with a spring-loaded device and in 0% (0/70) of lesions biopsied with a directional vacuum-assisted device (p = 0.01); and in 8% (5/60) of lesions sampled with less than 12 specimens per lesion and 0% (0/68) sampled with 12 or more specimens (p = 0.015). Lesion type, maximal lesion diameter, and type of imaging guidance (stereotactic or sonographic) were not significant factors in determining the presence of malignancy.

CONCLUSION. Diagnosis of radial scar based on core needle biopsy is likely to be reliable when there is no associated atypical hyperplasia at percutaneous biopsy, when the biopsy includes at least 12 specimens, and when mammographic findings are reconciled with histologic findings. When the lesion diagnosed by core needle biopsy as radial scar does not meet these criteria, excisional biopsy is indicated.

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