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Mount Sinai Medical Center Miami Beach, FL 33140
We read with interest the article by Brenner et al. [1] on core needle biopsy of radial scars or complex sclerosing lesions of the breast. We agree with the author's conclusion that the histologic finding of radial scar on core biopsy does not necessarily warrant excision. Our experience in nine patients who had a primary histopathologic diagnosis of radial scar on core biopsy (five presented radiologically as calcifications; two, as architectural distortions; and two, as masses) supports the findings of the study. No carcinoma was revealed on subsequent excisional biopsies; however, in three patients, associated atypical intraductal hyperplasia was found adjacent to the area of the radial scar.
However, we cannot agree with the authors' interpretation of their findings. The authors concluded that excisional biopsy is indicated when there is radial scar with associated atypical intraductal hyperplasia at percutaneous biopsy (when the biopsy does not include at least 12 specimens and when mammographic findings are not reconciled with histologic findings). They based their conclusion on the findings of carcinoma at excision in 28% (8/29) of radial scar lesions with associated atypical intraductal hyperplasia at percutaneous biopsy and 4% (5/128) of radial scars without associated atypical intraductal hyperplasia. However, the authors did not submit any data on the frequency of carcinoma in excisions of atypical intraductal hyperplasia without radial scar at core biopsy. The incidence of carcinoma at surgical excision after core biopsy for atypical intraductal hyperplasia varies from 4% to 60% from institution to institution [2].
Radial scars are benign breast lesions and are part of the sclerosing lesions–sclerosing adenosis spectrum [3]. The current recommendation for atypical intraductal hyperplasia is surgical excision. Any radial scar occurring in association with epithelial proliferations such as atypical intraductal hyperplasia must be separately considered and diagnosed.
We think that the authors cannot draw their conclusions without providing their frequency of subsequent carcinoma using the core needle biopsy finding of atypical intraductal hyperplasia in the absence of radial scar.
References
Eisenberg Keefer Breast Center John Wayne Cancer Institute Tower-Saint Johns Imaging Saint Johns Health Center Santa Monica, CA 90404–2032 UCLA Geffin School of Medicine Los Angeles, CA 90095-1721
On behalf of my coauthors and investigators, I thank Drs. Gombos and Poppiti for their comments on our report and their findings that are similar to the ones we presented. Their perspective on the nature of radial scars, as cited, may be of interest to some.
However, the focus of their criticism is difficult to reconcile with our study [1]. Our investigation attempts to assist radiologists who are faced with the management dilemma of finding histologic evidence of radial scar in specimens obtained by core needle biopsy. The issue of atypical intraductal hyperplasia as it relates to the coexistence of radial scar was carefully analyzed and reported. Reporting on atypical intraductal hyperplasia without radial scar is simply extraneous to our study and has been addressed by a large number of institutional studies [2], a prospective multiinstitutional study [3], and a large review in this journal [4].
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