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Radial Scars and Complex Sclerosing Lesions of the Breast: Prevalence of Malignancy and Natural History Under Active Surveillance

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

When needle core biopsies (NCBs) of the breast reveal radial scar or complex sclerosing lesions (RSLs), excision is often recommended despite a low risk of malignancy in the modern era. The optimal management of NCBs revealing RSLs is controversial, and understanding of the natural history of unresected RSLs is limited.

Methods

We retrospectively analyzed pathology and imaging data from 148 patients with NCB revealing RSL without atypia from 2015 to 2019 to determine the prevalence of malignancy and the behavior of RSLs undergoing active surveillance (AS).

Results

The mean age of patients was 52 years, and most lesions were screen-detected (91%). The median lesion size was 6.0 mm (range 2–39). Most patients (66%, n = 98) underwent immediate surgery, while 34% (n = 50) of patients underwent AS, with a median follow-up of 16 months (range 6–51). Of the excised RSLs, 99% (n = 97) were benign and 1% (n = 1) revealed ductal carcinoma in situ (DCIS). In 17% (n = 17) of cases, additional high-risk lesions were discovered upon excision. Among the 50 patients undergoing AS, no lesions progressed on interval imaging.

Conclusions

In this cohort, 99% of RSLs undergoing excision were benign, 1% revealed DCIS, and there were no invasive cancers. In the first study of patients with RSLs undergoing AS, we found that all lesions either remained stable or resolved. We propose that the vast majority of patients with RSL on NCB can be safely offered AS, and that routine excision is a low-value intervention.

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Acknowledgment

We thank our patients and their families, and members of the breast surgery, breast pathology, and breast radiology services at the breast center at New York-Presbyterian/Weill Cornell Medical Center for multidisciplinary care and helpful input into this study.

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Authors and Affiliations

  1. Department of Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA

    Elizabeth Kraft MD

  2. Division of Breast Surgery, Department of Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA

    Jessica N. Limberg MD, Lisa A. Newman MD, FACS, Rache Simmons MD, Alexander Swistel MD & Jennifer L. Marti MD, FACS

  3. Department of Radiology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA

    Katerina Dodelzon MD

  4. Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA

    Paula S. Ginter MD

Authors
  1. Elizabeth Kraft MD
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  2. Jessica N. Limberg MD
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  3. Katerina Dodelzon MD
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  4. Lisa A. Newman MD, FACS
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  5. Rache Simmons MD
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  6. Alexander Swistel MD
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  7. Paula S. Ginter MD
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  8. Jennifer L. Marti MD, FACS
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Corresponding author

Correspondence to Jennifer L. Marti MD, FACS.

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Disclosures

Elizabeth Kraft, Jessica N. Limberg, Katerina Dodelzon, Lisa A. Newman, Rache Simmons, Alexander Swistel, Paula S. Ginter, and Jennifer L. Marti declare no conflicts of interest.

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Kraft, E., Limberg, J.N., Dodelzon, K. et al. Radial Scars and Complex Sclerosing Lesions of the Breast: Prevalence of Malignancy and Natural History Under Active Surveillance. Ann Surg Oncol 28, 5149–5155 (2021). https://doi.org/10.1245/s10434-021-09713-5

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  • DOI: https://doi.org/10.1245/s10434-021-09713-5

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