Abstract：
OBJECTIVE: To determine the best management option (surgical excision versus imaging surveillance) following the diagnosis of pure radial scars (RSs) and RSs with associated additional high-risk lesions (HRLs) encountered on percutaneous core-needle breast biopsy.
METHODS: An IRB-approved retrospective review of the breast imaging reporting system database was performed to identify all cases of pure RS alone or RS plus an additional HRL (papilloma, atypia, lobular neoplasia) diagnosed on core-needle biopsy, from 2007 to 2016, at four breast centers in our institution. Cases with associated malignancy, discordant radiologic-pathologic results, or those lost to follow-up were excluded. The remaining cases were evaluated to determine results of either subsequent surgical excision or long-term follow-up imaging (minimum of two years). Additional data recorded included clinical presentation, breast density, personal and family history of breast cancer, lesion imaging characteristics, and biopsy method.
RESULTS: The study cohort included 111 patients with 111 lesions: 56.8% (63/111) with RS alone (pure) and 43.2% (48/111) with RS plus additional HRL(s). Out of the 63 radiologic-pathologic concordant pure RSs, there were no upgrades to malignancy in 51 subsequent surgical excisions or 12 long-term surveillance cases (0/63, 0%). Out of the 48 RSs plus additional HRL(s), there were 2 upgrades to malignancy (2/48, 4.2%).
CONCLUSIONS: Cases of radiologic-pathologic concordant pure RS diagnosed at core-needle biopsy do not require surgical excision. On the other hand, surgical excision should be considered for RS plus additional HRLs diagnosed at core-needle biopsy.
METHODS: An IRB-approved retrospective review of the breast imaging reporting system database was performed to identify all cases of pure RS alone or RS plus an additional HRL (papilloma, atypia, lobular neoplasia) diagnosed on core-needle biopsy, from 2007 to 2016, at four breast centers in our institution. Cases with associated malignancy, discordant radiologic-pathologic results, or those lost to follow-up were excluded. The remaining cases were evaluated to determine results of either subsequent surgical excision or long-term follow-up imaging (minimum of two years). Additional data recorded included clinical presentation, breast density, personal and family history of breast cancer, lesion imaging characteristics, and biopsy method.
RESULTS: The study cohort included 111 patients with 111 lesions: 56.8% (63/111) with RS alone (pure) and 43.2% (48/111) with RS plus additional HRL(s). Out of the 63 radiologic-pathologic concordant pure RSs, there were no upgrades to malignancy in 51 subsequent surgical excisions or 12 long-term surveillance cases (0/63, 0%). Out of the 48 RSs plus additional HRL(s), there were 2 upgrades to malignancy (2/48, 4.2%).
CONCLUSIONS: Cases of radiologic-pathologic concordant pure RS diagnosed at core-needle biopsy do not require surgical excision. On the other hand, surgical excision should be considered for RS plus additional HRLs diagnosed at core-needle biopsy.
摘要：
目的：在诊断为单纯的放射状瘢痕（RSs）和RSs并在经皮芯针乳腺活检中遇到其他相关的高危病变（HRL）后，确定最佳的治疗选择（手术切除与影像学检查）。
方法：对乳腺影像学报告系统数据库进行了IRB批准的回顾性审查，以识别所有单纯RS或RS加额外HRL（乳头状瘤，非典型,小叶瘤形成）在芯针活检中诊断，从2007年到2016年，在我们机构的四个乳房中心。伴有恶性肿瘤的病例，不一致的放射学-病理学结果，或者那些失去随访的人被排除在外.对其余病例进行评估，以确定后续手术切除或长期随访成像（至少两年）的结果。记录的其他数据包括临床表现，乳腺密度,乳腺癌的个人和家族史，病变影像学特征，和活检方法。
结果：研究队列包括111例患者，111个病灶：56.8%(63/111)单独使用RS（纯），43.2%(48/111)使用RS加其他HRL（s）。在63个放射学-病理学一致的纯RS中，在51例后续手术切除或12例长期监测病例(0/63,0%)中,未出现恶性升级.在48个RS加上额外的HRL(s)中，有2例升级为恶性肿瘤(2/48,4.2%).
结论：在芯针活检中诊断为放射学-病理学一致的纯RS的病例不需要手术切除。另一方面,对于在芯针活检中诊断出的RS和其他HRLs,应考虑手术切除.
方法：对乳腺影像学报告系统数据库进行了IRB批准的回顾性审查，以识别所有单纯RS或RS加额外HRL（乳头状瘤，非典型,小叶瘤形成）在芯针活检中诊断，从2007年到2016年，在我们机构的四个乳房中心。伴有恶性肿瘤的病例，不一致的放射学-病理学结果，或者那些失去随访的人被排除在外.对其余病例进行评估，以确定后续手术切除或长期随访成像（至少两年）的结果。记录的其他数据包括临床表现，乳腺密度,乳腺癌的个人和家族史，病变影像学特征，和活检方法。
结果：研究队列包括111例患者，111个病灶：56.8%(63/111)单独使用RS（纯），43.2%(48/111)使用RS加其他HRL（s）。在63个放射学-病理学一致的纯RS中，在51例后续手术切除或12例长期监测病例(0/63,0%)中,未出现恶性升级.在48个RS加上额外的HRL(s)中，有2例升级为恶性肿瘤(2/48,4.2%).
结论：在芯针活检中诊断为放射学-病理学一致的纯RS的病例不需要手术切除。另一方面,对于在芯针活检中诊断出的RS和其他HRLs,应考虑手术切除.
