Abstract：
OBJECTIVE: Radial sclerosing lesions (RSLs) are benign breast lesions composed of glandular and epithelial proliferations with stellate architecture and fibro-elastotic stroma, which can mimic invasive carcinoma on imaging. Surgical management following a core biopsy diagnosis of RSLs remains controversial.
RESULTS: We retrospectively identified core biopsies with RSLs without atypia who underwent subsequent surgical excision between 2015 and 2021. All core biopsy slides were reviewed to confirm the diagnosis. Imaging was reviewed to determine radiological-pathological concordance. An upgrade was defined as invasive carcinoma or ductal carcinoma in situ (DCIS) in the excision. The final cohort consisted of 130 core biopsies from 124 women (median age = 52 years, range = 27-76). The imaging modality was mammogram in 52 (40%) cases, MRI in 52 (40%) and ultrasound in 26 (20%). One hundred and seven (82%) core biopsies were vacuum-assisted and 23 (18%) were ultrasound-guided without vacuum assistance. The median lesion size on imaging was 9 mm (range = 2-41). Overall, two (1%) cases were upgraded at excision, including one microinvasive lobular carcinoma and one 2 mm focus of invasive mammary carcinoma with associated DCIS. In both cases, the upgraded foci of carcinoma were not closely associated with the biopsy site and were considered incidental upgrades.
CONCLUSIONS: This study adds to the body of literature supporting observation, rather than routine excision of radial sclerosing lesions without atypia.
RESULTS: We retrospectively identified core biopsies with RSLs without atypia who underwent subsequent surgical excision between 2015 and 2021. All core biopsy slides were reviewed to confirm the diagnosis. Imaging was reviewed to determine radiological-pathological concordance. An upgrade was defined as invasive carcinoma or ductal carcinoma in situ (DCIS) in the excision. The final cohort consisted of 130 core biopsies from 124 women (median age = 52 years, range = 27-76). The imaging modality was mammogram in 52 (40%) cases, MRI in 52 (40%) and ultrasound in 26 (20%). One hundred and seven (82%) core biopsies were vacuum-assisted and 23 (18%) were ultrasound-guided without vacuum assistance. The median lesion size on imaging was 9 mm (range = 2-41). Overall, two (1%) cases were upgraded at excision, including one microinvasive lobular carcinoma and one 2 mm focus of invasive mammary carcinoma with associated DCIS. In both cases, the upgraded foci of carcinoma were not closely associated with the biopsy site and were considered incidental upgrades.
CONCLUSIONS: This study adds to the body of literature supporting observation, rather than routine excision of radial sclerosing lesions without atypia.
摘要：
目的：放射状硬化性病变（RSLs）是由腺体和上皮增生组成的良性乳腺病变，具有星状结构和纤维弹性间质，可以在成像上模仿浸润性癌。核心活检诊断为RSL后的手术治疗仍存在争议。
结果：我们回顾性地确定了在2015年至2021年期间接受手术切除的无异型RSL核心活检。检查所有核心活检切片以确认诊断。对影像学进行了审查，以确定放射学-病理学的一致性。升级定义为切除术中的浸润性癌或导管原位癌（DCIS）。最终队列包括来自124名女性的130个核心活检（中位年龄=52岁，范围=27-76）。52例（40％）的影像学检查为乳房X线照片，MRI中52例(40%)和超声中26例(20%)。一百零七（82％）个核心活检是真空辅助的，而23（18％）个是超声引导的，没有真空辅助。影像学上的中位病变大小为9mm（范围=2-41）。总的来说,2例(1%)在切除时升级，包括一个微浸润性小叶癌和一个2毫米的浸润性乳腺癌与相关的DCIS病灶。在这两种情况下，癌灶的升级与活检部位没有密切关联,被认为是偶然升级.
结论：这项研究增加了支持观察的文献，而不是常规切除无异型的放射状硬化性病变。
结果：我们回顾性地确定了在2015年至2021年期间接受手术切除的无异型RSL核心活检。检查所有核心活检切片以确认诊断。对影像学进行了审查，以确定放射学-病理学的一致性。升级定义为切除术中的浸润性癌或导管原位癌（DCIS）。最终队列包括来自124名女性的130个核心活检（中位年龄=52岁，范围=27-76）。52例（40％）的影像学检查为乳房X线照片，MRI中52例(40%)和超声中26例(20%)。一百零七（82％）个核心活检是真空辅助的，而23（18％）个是超声引导的，没有真空辅助。影像学上的中位病变大小为9mm（范围=2-41）。总的来说,2例(1%)在切除时升级，包括一个微浸润性小叶癌和一个2毫米的浸润性乳腺癌与相关的DCIS病灶。在这两种情况下，癌灶的升级与活检部位没有密切关联,被认为是偶然升级.
结论：这项研究增加了支持观察的文献，而不是常规切除无异型的放射状硬化性病变。
