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Radial scars present a difficult problem within breast screening. A proportion contains a spectrum of pathological change, including invasive cancer [1]. For this reason, surgical excision has been recommended [1]. With increasing use of vacuum-assisted biopsy, recommendations are now in place to allow leaving these lesions without excision where no atypia is identified [2].  We present our series of 100 B3 radial scars consecutively diagnosed by 14-gauge core biopsy between 2004 and 2007. This includes 13 malignancies subsequently identified on surgical excision. Five were invasive (size, 2 mm to 11 mm), and eight were ductal carcinoma in situ (size, 3 mm to 22 mm). In three cases of invasive cancer <10 mm, no concomitant atypia was identified. In these cases, had vacuum-assisted biopsy not included the small invasive area, surgical excision would not have been recommended under current guidelines. Hence, the cancers would have remained undetected.  This information will continue to inform the debate surrounding surgical excision versus vacuum-assisted biopsy without excision in the management of radial scars.

Radial scars: to excise or not to excise?