Imaging Follow-up Versus Surgical Excision for Radial Scars Identified on Tomosynthesis-Guided Core Needle Biopsy.

Affiliation

The University of Texas MD Anderson Cancer, Department of Diagnostic Radiology, Division of Diagnostic Imaging, 1515 Holcombe Blvd., Unit 1350, Houston, TX 77030. Electronic address: [Email]

Abstract

OBJECTIVE : We investigated if imaging or pathology features could determine when imaging follow-up is appropriate after diagnosis of radial scar on digital breast tomosynthesis (DBT)-guided core needle biopsy (CNB).
METHODS : We conducted a retrospective review of all patients diagnosed with radial scars on DBT-guided CNB at our institution between November 2014 and December 2016. Cases were excluded if DCIS or invasive malignancy was present in the same core specimens. Patient age; needle size; number of cores; visibility on full-field digital mammography versus DBT; lesion size; presence of architectural distortion, mass, or calcifications; imaging stability; presence or absence of atypia; length of imaging follow-up, and excisional pathology were collected.
RESULTS : Of 45 eligible biopsies, 6 cases had radial scars with associated atypia and 39 cases had no associated atypia. Twenty-four patients underwent surgical excision, including all patients with atypia on CNB. One case (4%) was upstaged to DCIS on surgical excision after CNB revealed a radial scar with associated ADH. There was also a case without atypia on CNB, but excisional pathology revealed associated ADH. In cases with radial scars and associated atypia on CNB, the upstage rate was 17%. In cases without atypia on CNB that underwent surgical excision, the upstage rate was 0%. Imaging follow-up was available in 13 patients who did not undergo surgical excision, with stability in all 13 with a median follow-up of 18 months.
CONCLUSIONS : Annual imaging follow-up appears reasonable in selected patients with radial scars but no atypia on DBT-guided CNB.

Keywords

Breast,Core needle biopsy,Radial scar,Tomosynthesis,

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