Pre-operative fine-needle aspiration cytology (FNAC) and core biopsy (CB) of radial scars (RS) and complex sclerosing lesions (CSL)

Many screen-detected radial scars (RS) and complex sclerosing lesions (CSL) are associated with malignant disease, and the role of fine-needle aspiration cytology (FNAC) and core biopsy (CB) in pre-operative evaluation remains uncertain. Our aim was to determine the diagnostic accuracy of FNAC and CB in the management of these lesions. The results of FNAC and CB in 54 women (age range 36–72 years) with a definitive diagnosis of RS or CSL at excision biopsy between January 1997 and January 2002 were reviewed. FNAC in 37 patients was inadequate in 15 (41%). Sixteen patients were classified as C2 (43%), three as C3 (8%), one as C4 (3%) and two as C5 (5%). CB in 37 patients was graded as B1 in four patients (11%), B2 in 27 (73%), B3 in four (11%) and B4 in two (5%). Four cases of ductal carcinoma in situ and three of invasive carcinoma were identified following excision biopsy. None was diagnosed pre-operatively by CB. One invasive carcinoma was diagnosed on FNAC. One patient was classified as B4 on CB. Another patient had a false positive result on FNAC. Only 11 out of 37 women (30%) had a positive diagnosis of RS or CSL on pre-operative CB. A further seven women (19%) had CB results suggestive of RS or CSL.

Pre-operative FNAC and CB are insufficient to accurately diagnose significant pathology associated with RS or CSL. Excision biopsy remains essential.