Department of Surgical Oncology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Am J Clin Oncol. 2013 Feb;36(1):7-11. doi: 10.1097/COC.0b013e3182354a3f.
Radial scar (RS) is characterized by a fibroelastic core with entrapped ducts and lobules. Association with carcinoma is not uncommon. There is some dilemma as to the need for excisional biopsy or follow-up after RS diagnosis on core biopsy.
To determine the necessity of excisional biopsy after the diagnosis of benign RS by core biopsy.
A total of 67 RS specimens associated with benign findings on core biopsy obtained between 2003 and 2008 were reviewed. They were grouped by their accompanying histopathologic features found upon subsequent surgical excision: benign, high-risk lesion (HRL), or carcinoma. Demographic features, radiologic findings, and needle gauge were compared within subgroups.
After surgical excision, 15 (22.4%) patients in the benign group were upgraded to a HRL, 4 (5.9%) patients were upgraded to carcinoma, and 48 (71.6%) remained benign. We found that malignancy is associated with RS more frequently if the patient is older and postmenopausal. Other variables such as symptoms at presentation, presence and type of abnormality on mammography (Breast Imaging Reporting and Data System score), breast density, size of biopsy needle used, and number of core samples retrieved did not help to predict the presence of carcinoma.
The HRL and cancer upgrade rate of RS, requiring further intervention such as surgery or chemoprevention, is 28% in this study. However, we found that age and menopausal status may be taken into consideration when making the decision to follow up or excise the RS diagnosed on core biopsy. There is insufficient data to support the predictive value of any variables. Therefore, RS associated with benign findings on core biopsy should be excised.
放射状瘢痕（RS）的特征是具有被捕获的导管和小叶的纤维弹性核心。与癌的关联并不罕见。在 RS 经核心活检诊断后，是否需要进行切除活检或随访存在一些争议。
确定在核心活检诊断为良性 RS 后是否需要进行切除活检。
回顾了 2003 年至 2008 年间获得的总共 67 例与核心活检良性结果相关的 RS 标本。根据随后手术切除时发现的伴随组织病理学特征将其分组：良性、高危病变（HRL）或癌。比较了亚组内的人口统计学特征、影像学发现和针规。
在手术切除后，良性组中有 15 例（22.4%）患者升级为 HRL，4 例（5.9%）患者升级为癌，48 例（71.6%）仍为良性。我们发现，如果患者年龄较大且处于绝经后状态，恶性肿瘤与 RS 相关的可能性更高。其他变量，如发病时的症状、乳腺 X 线摄影（乳腺影像报告和数据系统评分）的异常存在和类型、乳腺密度、活检针的大小以及所取的核心样本数量，均无助于预测癌的存在。
在这项研究中，RS 需要进一步干预（如手术或化学预防）的 HRL 和癌症升级率为 28%。然而，我们发现，在决定对核心活检诊断为 RS 的患者进行随访或切除时，可以考虑年龄和绝经状态。目前尚缺乏支持任何变量具有预测价值的数据。因此，与核心活检良性结果相关的 RS 应予以切除。
