Abstract：
BACKGROUND. Radial scars are more commonly identified on digital breast tomosynthesis (DBT) than on digital mammography (DM). Nonetheless, universal guidelines for radial scar management in the current era of DBT are lacking. OBJECTIVE. The purpose of this study was to determine the upstaging rates of screening DBT-detected radial scars with and without atypia and to identify features related to upstaging risk. METHODS. This retrospective study included patients who underwent core needle biopsy (CNB) showing a radial scar after screening DBT and DM from January 1, 2013, to December 31, 2020. Patients without surgical excision or at least 2 years of imaging follow-up after CNB were excluded. Rates of upstaging to breast cancer (ductal carcinoma in situ [DCIS] or invasive disease) were compared between radial scars with and without atypia at CNB. Associations of upstaging with patient, imaging, and pathologic variables were explored using standard statistical tests. RESULTS. Of 165 women with 171 radial scars, the final study sample included 153 women (mean age, 56 years; range, 33-83 years) with 159 radial scars that underwent surgical excision (80.5%, 128/159) or at least 2 years of imaging follow-up (19.5%, 31/159). Seven radial scars were upstaged to DCIS and one to invasive disease. Therefore, the up-staging rate of radial scars to cancer was 5.0% (8/159). The upstaging rate of radial scars without atypia at CNB was 1.6% (2/129) and that of radial scars with atypia was 20.0% (6/30) (p < .001). On multivariable analysis, features associated with higher upstaging risk included a prior breast cancer diagnosis (62.5% vs 4.8%; p = .01) and the presence of atypia at CNB (75.0% vs 15.9%; p = .02). The upstaging rate according to mammographic finding type was 7.1% (1/14) for asymmetries, 12.5% (2/16) for masses, 5.3% (5/95) for architectural distortion, and 0.0% (0/34) for calcifications. CONCLUSION. Screening-detected radial scars without atypia at CNB have a low upstaging rate to breast cancer of 1.6%. CLINICAL IMPACT. Imaging surveillance rather than surgery is a reasonable approach for radial scars without atypia, particularly for those presenting as calcifications.
摘要：
背景：放射状疤痕在数字乳房断层合成（DBT）上比在数字乳房X线照相术（DM）上更常见。尽管如此，目前缺乏DBT时代放射状瘢痕管理的通用指南。目的：确定筛查DBT检测到的有或没有非典型性的放射状疤痕的升级率，并确定与升级风险相关的特征。方法：这项回顾性研究包括2013年1月1日至2020年12月31日在筛查DBT和DM后接受粗针活检（CNB）显示放射状瘢痕的患者。无手术切除或CNB后至少2年影像学随访的患者被排除在外。比较了在CNB有无异型性的放射状疤痕之间乳腺癌[导管原位癌（DCIS）或浸润性疾病]的升级率。升级与患者的关联，成像,和病理变量使用标准统计检验进行研究.结果：165名女性有171个放射状疤痕，最终研究样本包括153名女性(平均年龄，56年；范围，33-83岁），159个接受手术切除的放射状疤痕（80.5%，128/159）或至少2年的影像学随访（19.5％，31/159)。七个放射状疤痕被升级为DCIS，一个被升级为浸润性疾病。因此,放射状疤痕的癌症分期率为5.0％（8/159）。CNB无非典型性的放射状疤痕的升级率为1.6％（2/129），有非典型性的放射状疤痕的升级率为20.0％（6/30）（p<.001）。在多变量分析中，与较高分期风险相关的特征包括先前的乳腺癌诊断(62.5%vs4.8%，p=.01）和CNB中异型性的存在（75.0％对15.9％，p=.02）。根据乳房X线摄影发现类型，不对称性的升级率为7.1％（1/14），6.7%(1/15)为群众，6.3%（6/96）的建筑失真，钙化占0.0%(0/34)。结论：在CNB中筛查检测到的无异型放射状瘢痕对乳腺癌的分期率低，为1.6％。临床影响：影像学监测而不是手术是治疗无非典型性的放射状瘢痕的合理方法，特别是对于那些表现为钙化的人。
