AJR: Surgery necessary to rule out malignancy in women with radial scars

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Women with radial scars classified at percutaneous biopsy should undergo surgical excisions to rule out underlying malignancy, according to a study published in the April issue of the American Journal of Roentgenology.

Anna Linda, MD, from the Institute of Radiology, Azienda Ospedaliero Universitaria, University of Udine in Udine, Italy, and colleagues, said that because a radial scar is associated with underlying malignancy, a percutaneous biopsy is not considered to be reliable in ruling out malignant foci at the periphery of the lesion.

The study included 62 patients with radial scars based upon image-guided biopsy results. Of the 62 lesions, five proved to be malignant at surgical excision, 40 were found to be high risk, and the remaining 17 were benign. 

According to the authors, carcinomas associated with radial scars were three DCIS, two low-grade and one intermediate-grade ductal carcinoma in situ; one grade 1 invasive ductal carcinoma, not otherwise specified; and one grade 2 invasive lobular carcinoma. Of the 40 high-risk lesions, 33 were radial scar, six were atypical ductal hyperplasia and one was flat epithelial atypia.

The percutaneous biopsy underestimation rate of malignancy was 8 percent: 9 percent for sonography-guided 14-gauge biopsies and 5 percent for stereotactically guided 11-gauge vacuum-assisted biopsies.

Thirty-eight of the 62 lesions were detected on mammography: 19 were shown as architectural distortions, 11 as calcifications and eight as masses . Based on the results of surgical excision, the authors found, three of five malignancies were detected on mammography. Malignancies were found in one of 19 architectural distortions, in two of 11 lesions presenting as microcalcifications and in none of eight masses.

The researchers found that 45 of 62 lesions were detected on sonography: 17 were categorized as a circumscribed mass and 28 as a non-circumscribed mass. The authors said that based on the results of surgical excision, four of five malignancies were detected on sonography.

“A diagnosis of a radial scar based on percutaneous biopsy results does not exclude an associated malignancy at subsequent surgical excision, and mammographic and sonographic appearance of a lesion diagnosed as a radial scar are not able to predict which lesions will have associated malignancy at subsequent surgical excision,” Linda said. Our results suggest that surgical excisioin is required for lesions yielding radial scars at percutaneous biopsy regardless of their mammographic and sonographic appearance.”