Kalife Elizabeth Tágide, Lourenco Ana P, Baird Grayson L, Wang Yihong
Department of Pathology, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
Breast J. 2016 Nov;22(6):637-644. doi: 10.1111/tbj.12645. Epub 2016 Aug 19.
To determine the incidence of malignancy for radial scars (RS)/radial sclerosing lesions (RSL) without associated atypia or malignancy identified at needle biopsy. Retrospective review of the pathology data base from January 2004 to July 2013 yielded 100 needle biopsies diagnosed as RS/RSL without associated atypia/malignancy. The RS/RSL was considered "incidental" if the target was calcifications and "targeted" if imaging revealed a mass, architectural distortion, or suspicious magnetic resonance imaging enhancement. The electronic medical record was used to identify surgical pathology, follow-up imaging, and clinical course; all pathology slides and imaging were reviewed by a board-certified pathologist and radiologist, respectively. Patient age, laterality, RS/RSL size, microcalcifications, and associated benign lesions were recorded. Among 100 cases, 54 were "incidental" and 46 were "targeted." In the incidental group, 14 underwent excision, 30 had imaging follow-up, and 10 were lost to follow-up. In the targeted group, 27 underwent excision, 11 had imaging follow-up, and 8 were lost to follow-up. Atypia was identified in four excisions: three from the incidental group and one from the targeted group. Among these, three had negative imaging follow-up (mean 45 months; range 15-60 months); the fourth patient (one of the incidental group) underwent excision alone. One of the 27 "targeted" patients who underwent excision developed ductal carcinoma in situ of the contralateral breast at 96 months. There have been no ipsilateral malignancies. We found no evidence of associated malignancy at excision for either incidental or targeted biopsies of RS/RSL without atypia. Our study suggests that close imaging follow-up is adequate for patients with RS/RSL without associated atypia/malignancy on needle biopsy.
确定在针吸活检时未发现相关异型性或恶性肿瘤的放射状瘢痕（RS）/放射状硬化性病变（RSL）的恶性肿瘤发生率。回顾性分析2004年1月至2013年7月的病理数据库，共获得100例经诊断为RS/RSL且无相关异型性/恶性肿瘤的针吸活检病例。如果目标是钙化，则RS/RSL被视为“偶然发现”；如果影像学检查发现肿块、结构扭曲或可疑的磁共振成像强化，则视为“有针对性的”。利用电子病历确定手术病理、随访影像学检查和临床病程；所有病理切片和影像学检查分别由一名获得委员会认证的病理学家和放射科医生进行复查。记录患者年龄、病变侧别、RS/RSL大小、微钙化以及相关的良性病变。100例病例中，54例为“偶然发现”，46例为“有针对性的”。在偶然发现组中，14例行切除手术，30例进行影像学随访，10例失访。在有针对性的组中，27例行切除手术，11例进行影像学随访，8例失访。在4例切除病例中发现了异型性：3例来自偶然发现组，1例来自有针对性的组。其中，3例影像学随访结果为阴性（平均45个月；范围15 - 60个月）；第4例患者（偶然发现组中的1例）仅接受了切除手术。27例接受切除手术的“有针对性的”患者中有1例在96个月时对侧乳腺发生原位导管癌。未发现同侧恶性肿瘤。我们发现，对于针吸活检时无异型性的RS/RSL，无论是偶然发现还是有针对性的活检，切除时均无相关恶性肿瘤的证据。我们的研究表明，对于针吸活检时无相关异型性/恶性肿瘤的RS/RSL患者，密切的影像学随访就足够了。
