Miller Cynthia L, West Jane A, Bettini Anna C, Koerner Frederick C, Gudewicz Thomas M, Freer Phoebe E, Coopey Suzanne B, Gadd Michele A, Hughes Kevin S, Smith Barbara L, Rafferty Elizabeth, Specht Michelle C
Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Breast Cancer Res Treat. 2014 Jun;145(2):331-8. doi: 10.1007/s10549-014-2958-y. Epub 2014 Apr 19.
Radial scars (RS's) are benign breast lesions known to be associated with carcinomas and other high-risk lesions (HRL's). The upgrade rate to carcinoma after core biopsy revealing RS is 0-40 %. We sought to determine the outcomes of RS with and without HRL diagnosed by core biopsy. Patients who underwent core biopsy revealing RS without carcinoma at our institution between 1/1996 and 11/2012 were identified from a surgical pathology database. Retrospective chart review was utilized to classify patients as RS-no HRL or RS-HRL. HRL was defined as ADH, LCIS, and/or ALH. We determined upgrade rate to carcinoma at surgical excision, and upgrade to HRL for RS-no HRL patients. Univariate analysis was performed to identify risk factors for upgrade in RS-no HRL patients. 156 patients underwent core biopsy revealing RS, 131 RS-no HRL (84 %), and 25 RS-HRL (16 %). The overall rate of upgrade to invasive carcinoma was 0.8 % (1/124). 1.0 % (1/102) of RS-no HRL and 13.6 % (3/22) of RS-HRL patients were upgraded to DCIS (P = 0.0023). The upgrade of RS-no HRL to HRL at excision was 21.6 % (22/102). By univariate analysis, RS-no HRL with radiologic appearance of a mass/architectural distortion had a significantly higher rate of upgrade to HRL or carcinoma compared with calcifications (P = 0.03). Excision of RS to rule out associated invasive carcinoma is not warranted, given a <1 % rate of upgrade at excision. However, excision to evaluate for non-invasive cancer or HRL may be considered to help guide clinical decision-making about use of chemoprevention.
放射状瘢痕（RS）是已知与癌及其他高危病变（HRL）相关的乳腺良性病变。在粗针活检发现RS后升级为癌的比例为0%至40%。我们试图确定经粗针活检诊断为有或无HRL的RS的转归情况。从手术病理数据库中识别出1996年1月至2012年11月期间在我们机构经粗针活检发现无癌的RS患者。通过回顾病历将患者分类为无HRL的RS或有HRL的RS。HRL定义为非典型导管增生（ADH）、小叶原位癌（LCIS）和/或小叶腺病（ALH）。我们确定了手术切除时升级为癌的比例，以及无HRL的RS患者升级为HRL的比例。进行单因素分析以确定无HRL的RS患者升级的危险因素。156例患者经粗针活检发现RS，其中131例为无HRL的RS（84%），25例为有HRL的RS（16%）。升级为浸润性癌的总体比例为0.8%（1/124）。无HRL的RS患者中有1.0%（1/102）升级为导管原位癌（DCIS），有HRL的RS患者中有13.6%（3/22）升级为DCIS（P = 0.0023）。无HRL的RS在切除时升级为HRL的比例为21.6%（22/102）。单因素分析显示，与钙化表现相比，具有肿块/结构扭曲放射学表现的无HRL的RS升级为HRL或癌的比例显著更高（P = 0.03）。鉴于切除时升级比例<1%，因此没有必要切除RS以排除相关浸润性癌。然而，为评估非浸润性癌或HRL而进行切除可有助于指导关于化学预防使用的临床决策。
