University of Kansas Medical Center, Kansas City, Kansas.
Division of Breast Imaging, Department of Radiology, The University of Kansas Health System, Kansas City, Kansas.
J Surg Res. 2022 Nov;279:611-618. doi: 10.1016/j.jss.2022.06.048. Epub 2022 Aug 1.
The need for routine surgical excision of a radial sclerosing lesions (RSL) of the breast identified on percutaneous biopsy remains controversial, as contemporary upgrade rates are lower than historically cited.
A prospectively-maintained database of high-risk breast biopsies undergoing multidisciplinary review at a single institution was queried to identify cases of RSL from 2/2015 to 11/2020. Demographic, radiologic, and pathologic variables were summarized using frequencies and analyzed in association with RSL excision status using mixed-effects logistic regression or Fisher's exact tests.
217 RSL were identified, diagnosed at a mean age of 57 y. The median imaging size was 1.3 cm and the majority had estimated >50% of the target removed by core needle biopsy. 32.3% underwent surgical excision of the RSL biopsy site and 2/70 (2.9%) upgraded to ductal carcinoma in situ (DCIS) on final surgical pathology. Upgrade was significantly higher for atypical RSL (P = 0.02). None of the RSL (n = 60) without atypia who had undergone excision were upgraded. For those omitting surgical excision, there was no subsequent breast cancer diagnosis at the RSL site over a mean follow-up of 23 mo.
Surgical excision may be omitted for RSL without atypia as this group has 0% risk of upgrade after multidisciplinary review.
在经皮活检中发现的乳腺放射性硬化性病变（RSL）需要常规手术切除，但这仍然存在争议，因为目前的升级率低于历史报道。
对一家机构进行的多学科审查的高风险乳腺活检的前瞻性维护数据库进行了查询，以确定 2015 年 2 月至 2020 年 11 月期间的 RSL 病例。使用频率总结了人口统计学、影像学和病理学变量，并使用混合效应逻辑回归或 Fisher 精确检验分析了与 RSL 切除状态的关联。
共发现 217 例 RSL，平均年龄为 57 岁。影像学大小中位数为 1.3cm，大多数患者通过核心针活检切除了>50%的目标组织。32.3%的患者进行了 RSL 活检部位的手术切除，70 例中有 2 例（2.9%）在最终外科病理中升级为导管原位癌（DCIS）。非典型 RSL 的升级率显著更高（P=0.02）。无典型增生的 60 例 RSL（n=60）中，无 1 例在切除后升级。对于那些不进行手术切除的患者，在平均 23 个月的随访中，RSL 部位没有后续的乳腺癌诊断。
对于无非典型增生的 RSL，可以省略手术切除，因为多学科审查后这组患者升级的风险为 0%。
