Clinical and Radiologic Follow‐up Study for Biopsy Diagnosis of Radial Scar/Radial Sclerosing Lesion without Other Atypia

Abstract To determine the incidence of malignancy for radial scars (RS)/radial sclerosing lesions (RSL) without associated atypia or malignancy identified at needle biopsy. Retrospective review of the pathology data base from January 2004 to July 2013 yielded 100 needle biopsies diagnosed as RS/RSL without associated atypia/malignancy. The RS/RSL was considered “incidental” if the target was calcifications and “targeted” if imaging revealed a mass, architectural distortion, or suspicious magnetic resonance imaging enhancement. The electronic medical record was used to identify surgical pathology, follow‐up imaging, and clinical course; all pathology slides and imaging were reviewed by a board‐certified pathologist and radiologist, respectively. Patient age, laterality, RS/RSL size, microcalcifications, and associated benign lesions were recorded. Among 100 cases, 54 were “incidental” and 46 were “targeted.” In the incidental group, 14 underwent excision, 30 had imaging follow‐up, and 10 were lost to follow‐up. In the targeted group, 27 underwent excision, 11 had imaging follow‐up, and 8 were lost to follow‐up. Atypia was identified in four excisions: three from the incidental group and one from the targeted group. Among these, three had negative imaging follow‐up (mean 45 months; range 15–60 months); the fourth patient (one of the incidental group) underwent excision alone. One of the 27 “targeted” patients who underwent excision developed ductal carcinoma in situ of the contralateral breast at 96 months. There have been no ipsilateral malignancies. We found no evidence of associated malignancy at excision for either incidental or targeted biopsies of RS/RSL without atypia. Our study suggests that close imaging follow‐up is adequate for patients with RS/RSL without associated atypia/malignancy on needle biopsy.