Radial Scars without Atypia Diagnosed at Imaging-guided Needle Biopsy: How Often is Associated Malignancy Found at Subsequent Surgical Excision, and do Mammography and Sonography Predict which Lesions are Malignant?

Anna Linda; Chiara Zuiani; Alessandro Furlan; Viviana Londero; Rossano Girometti; Piernicola Machin; Massimo Bazzocchi

Disclosures

Am J Roentgenol. 2010;194(4):1146-1151. 

In This Article

Results

Final Pathology Results

Of the 62 lesions, five (8%) proved to be malignant at surgical excision; 40 (65%), high risk; and the remaining 17 (27%), benign. Carcinomas associated with radial scars were three DCIS, two low-grade and one intermediate-grade DCIS; one grade 1 invasive ductal carcinoma, not otherwise specified; and one grade 2 invasive lobular carcinoma. Of the 40 high-risk lesions, 33 (82.5%) were radial scar, six (15%) were atypical ductal hyperplasia, and one (2.5%) was flat epithelial atypia. Of the 17 benign lesions, eight (47%) were fibrocystic changes, seven (41%) were sclerosing adenosis, and two (12%) were usual ductal hyperplasia.

The percutaneous biopsy underestimation rate of malignancy was 8% (5/62): 9% (4/43) for sonography-guided 14-gauge biopsies and 5% (1/19) for stereotactically guided 11-gauge vacuum-assisted biopsies (p = 1.000).

A summary of all cases of malignant lesions diagnosed as radial scars without atypia at percutaneous biopsy is shown in Table 1.

Mammographic Findings

Thirty-eight (61%) of the 62 lesions were detected on mammography: 19 (50%) were shown as architectural distortions, 11 (29%) as calcifications, and eight (21%) as masses.

Based on the results of surgical excision, three of five malignancies (60%) were detected on mammography. Malignancies were found in one of 19 architectural distortions (5%), in two of 11 lesions presenting as microcalcifications (18%), and in none of eight masses (0%) (p = 0.291).

In the first case of microcalcifications, a hypoechoic mass was shown on sonography, and percutaneous biopsy was performed under sonographic guidance. In the second case, the only finding was a cluster of indeterminate microcalcifications (Fig. 1), and percutaneous biopsy was performed under stereotactic guidance with an 11-gauge vacuum-assisted biopsy device; 13 specimens were obtained. This lesion was upgraded to low-grade DCIS at surgical excision.

Figure 1.

54-year-old woman with radial scar without atypia found at stereotactically guided 11-gauge vacuum-assisted biopsy that was upgraded to low-grade ductal carcinoma in situ at excisional biopsy (lesion 1 in Table 1).
A, Magnification mammogram shows clustered amorphous calcifications (arrow).
B, Radiograph of biopsy specimens shows calcifications (arrow) in one of 13 specimens.

Sonographic Findings

Forty-five of 62 lesions (73%) were detected on sonography: 17 (38%) were categorized as a circumscribed mass and 28 (62%), as a noncircumscribed mass.

Based on the results of surgical excision, four of five malignancies (80%) were detected on sonography. All four malignancies (14%) were found among noncircumscribed masses, whereas none (0%) was found among circumscribed masses (p = 0.281). One example of a noncircumscribed mass that was upgraded to malignancy, an intermediate-grade DCIS, at surgical excision is shown in Figure 2. Percutaneous biopsy was performed under sonographic guidance using an automated biopsy gun with a 14-gauge needle, and five specimens were obtained.

Figure 2.

57-year-old woman with family history of breast cancer with radial scar without atypia found at 14-gauge biopsy. Lesion was upgraded to intermediate-grade ductal carcinoma in situ at excisional biopsy (lesion 4 in Table 1). Sonogram shows 10-mm oval hypoechoic mass with parallel orientation and no vascularity in lower outer quadrant of left breast. Bilateral mammograms (not shown) were negative.

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