Radial Scar of the Breast: Is It possible to avoid surgery?

Publication date: Available online 3 February 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): A.I. Ferreira, S. Borges, A. Sousa, C. Ribeiro, A. Mesquita, P.C. Martins, M. Peyroteo, N. Coimbra, C. Leal, P. Reis, J.A. Sousa
IntroductionBreast radial scar (RS) management remains controversial. The need for surgical excision is supported by the concern of an associated high-grade lesion missed in the initial biopsy.The aim of this study was to assess histologic upgrade rate after a percutaneous biopsy, to determine if vacuum assisted biopsy prevents the need for subsequent RS surgical resection and to evaluate the upgrade risk factors.Patients and MethodsThis was a uni-institutional retrospective study of consecutive patients with RS histologically diagnosed from January 2010 to December 2015.ResultsA total of 113 cases of RS were diagnosed during the study period. We verify that there was a histologic upgrade in 22 (19.5%) cases.The upgrade risk factors were the type of biopsy performed, the presence of atypia on initial histology, the presence of calcifications as well as the number of fragments obtained in the biopsy (p<0.05).The biopsy type was vacuum assisted in 25 (22.1%). The upgrade rate in the vacuum assisted biopsy group was 4.0%, whereas in the standard core needle biopsy group was 23,9% (p=0.041).Discussion and ConclusionIn our study we demonstrated that the risk of upgrade after a RS diagnosis depends on the type of biopsy performed, the presence of atypia, the presence of calcifications and the number of fragments obtained. When a standard core biopsy is performed the risk of upgrade and malignancy is not negligible, and surgery is indicated. When the biopsy is vacuum assisted, the risk of upgrade and malignancy is significantly decreased and so the indication for excisional biopsy seems not to be so imperative.



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