Percutaneous core needle biopsy of radial scars of the breast: When is excision necessary?

R. James Brenner, Roger J. Jackman, Steve H. Parker, W. Phill Evans, Liane Philpotts, Beth M. Deutch, Mary C. Lechner, Daniel Lehrer, Paul Sylvan, Rebecca Hunt, Steven J. Adler, Nancy Forcier

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Abstract

OBJECTIVE. This study was conducted to evaluate the outcome of cases of radial scar diagnosed by percutaneous core needle biopsy. MATERIALS AND METHODS. Of 198 nonpalpable lesions diagnosed with radial scars found at core needle biopsy, 157 lesions constituting the study group had undergone surgical excision (n = 102) or mammographic surveillance after biopsy for at least 24 months (median, 38 months; n = 55). Mammographic lesion type, lesion size, biopsy guidance method, biopsy device, number of specimens per lesion, and presence of atypical hyperplasia at percutaneous biopsy were retrospectively analyzed. Results were compared with histologic findings at surgery or mammographic findings during surveillance. RESULTS. Carcinoma was found at excision in 28% (8/29) of lesions with associated atypical hyperplasia at percutaneous biopsy and 4% (5/128) of lesions without associated atypia (p < 0.0001). In the latter group, carcinoma was found at excision in 3% (2/60) of masses, 8% (3/40) of architectural distortions, and 0% (0/28) of microcalcification lesions. Malignancy was missed in 9% (5/58) of lesions biopsied with a spring-loaded device and in 0% (0/70) of lesions biopsied with a directional vacuum-assisted device (p = 0.01); and in 8% (5/60) of lesions sampled with less than 12 specimens per lesion and 0% (0/68) sampled with 12 or more specimens (p = 0.015). Lesion type, maximal lesion diameter, and type of imaging guidance (stereotactic or sonographic) were not significant factors in determining the presence of malignancy. CONCLUSION. Diagnosis of radial scar based on core needle biopsy is likely to be reliable when there is no associated atypical hyperplasia at percutaneous biopsy, when the biopsy includes at least 12 specimens, and when mammographic findings are reconciled with histologic findings. When the lesion diagnosed by core needle biopsy as radial scar does not meet these criteria, excisional biopsy is indicated.

Original languageEnglish (US)
Pages (from-to)1179-1184
Number of pages6
JournalAmerican Journal of Roentgenology
Volume179
Issue number5
StatePublished - Nov 2002

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Large-Core Needle Biopsy
Cicatrix
Breast
Biopsy
Hyperplasia
Equipment and Supplies
Carcinoma
Calcinosis
Vacuum
Neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Brenner, R. J., Jackman, R. J., Parker, S. H., Evans, W. P., Philpotts, L., Deutch, B. M., ... Forcier, N. (2002). Percutaneous core needle biopsy of radial scars of the breast: When is excision necessary? American Journal of Roentgenology, 179(5), 1179-1184.

Percutaneous core needle biopsy of radial scars of the breast : When is excision necessary? / Brenner, R. James; Jackman, Roger J.; Parker, Steve H.; Evans, W. Phill; Philpotts, Liane; Deutch, Beth M.; Lechner, Mary C.; Lehrer, Daniel; Sylvan, Paul; Hunt, Rebecca; Adler, Steven J.; Forcier, Nancy.

In: American Journal of Roentgenology, Vol. 179, No. 5, 11.2002, p. 1179-1184.

Research output: Contribution to journalArticle

Brenner, RJ, Jackman, RJ, Parker, SH, Evans, WP, Philpotts, L, Deutch, BM, Lechner, MC, Lehrer, D, Sylvan, P, Hunt, R, Adler, SJ & Forcier, N 2002, 'Percutaneous core needle biopsy of radial scars of the breast: When is excision necessary?', American Journal of Roentgenology, vol. 179, no. 5, pp. 1179-1184.
Brenner RJ, Jackman RJ, Parker SH, Evans WP, Philpotts L, Deutch BM et al. Percutaneous core needle biopsy of radial scars of the breast: When is excision necessary? American Journal of Roentgenology. 2002 Nov;179(5):1179-1184.
Brenner, R. James ; Jackman, Roger J. ; Parker, Steve H. ; Evans, W. Phill ; Philpotts, Liane ; Deutch, Beth M. ; Lechner, Mary C. ; Lehrer, Daniel ; Sylvan, Paul ; Hunt, Rebecca ; Adler, Steven J. ; Forcier, Nancy. / Percutaneous core needle biopsy of radial scars of the breast : When is excision necessary?. In: American Journal of Roentgenology. 2002 ; Vol. 179, No. 5. pp. 1179-1184.
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title = "Percutaneous core needle biopsy of radial scars of the breast: When is excision necessary?",
abstract = "OBJECTIVE. This study was conducted to evaluate the outcome of cases of radial scar diagnosed by percutaneous core needle biopsy. MATERIALS AND METHODS. Of 198 nonpalpable lesions diagnosed with radial scars found at core needle biopsy, 157 lesions constituting the study group had undergone surgical excision (n = 102) or mammographic surveillance after biopsy for at least 24 months (median, 38 months; n = 55). Mammographic lesion type, lesion size, biopsy guidance method, biopsy device, number of specimens per lesion, and presence of atypical hyperplasia at percutaneous biopsy were retrospectively analyzed. Results were compared with histologic findings at surgery or mammographic findings during surveillance. RESULTS. Carcinoma was found at excision in 28{\%} (8/29) of lesions with associated atypical hyperplasia at percutaneous biopsy and 4{\%} (5/128) of lesions without associated atypia (p < 0.0001). In the latter group, carcinoma was found at excision in 3{\%} (2/60) of masses, 8{\%} (3/40) of architectural distortions, and 0{\%} (0/28) of microcalcification lesions. Malignancy was missed in 9{\%} (5/58) of lesions biopsied with a spring-loaded device and in 0{\%} (0/70) of lesions biopsied with a directional vacuum-assisted device (p = 0.01); and in 8{\%} (5/60) of lesions sampled with less than 12 specimens per lesion and 0{\%} (0/68) sampled with 12 or more specimens (p = 0.015). Lesion type, maximal lesion diameter, and type of imaging guidance (stereotactic or sonographic) were not significant factors in determining the presence of malignancy. CONCLUSION. Diagnosis of radial scar based on core needle biopsy is likely to be reliable when there is no associated atypical hyperplasia at percutaneous biopsy, when the biopsy includes at least 12 specimens, and when mammographic findings are reconciled with histologic findings. When the lesion diagnosed by core needle biopsy as radial scar does not meet these criteria, excisional biopsy is indicated.",
author = "Brenner, {R. James} and Jackman, {Roger J.} and Parker, {Steve H.} and Evans, {W. Phill} and Liane Philpotts and Deutch, {Beth M.} and Lechner, {Mary C.} and Daniel Lehrer and Paul Sylvan and Rebecca Hunt and Adler, {Steven J.} and Nancy Forcier",
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T1 - Percutaneous core needle biopsy of radial scars of the breast

T2 - When is excision necessary?

AU - Brenner, R. James

AU - Jackman, Roger J.

AU - Parker, Steve H.

AU - Evans, W. Phill

AU - Philpotts, Liane

AU - Deutch, Beth M.

AU - Lechner, Mary C.

AU - Lehrer, Daniel

AU - Sylvan, Paul

AU - Hunt, Rebecca

AU - Adler, Steven J.

AU - Forcier, Nancy

PY - 2002/11

Y1 - 2002/11

N2 - OBJECTIVE. This study was conducted to evaluate the outcome of cases of radial scar diagnosed by percutaneous core needle biopsy. MATERIALS AND METHODS. Of 198 nonpalpable lesions diagnosed with radial scars found at core needle biopsy, 157 lesions constituting the study group had undergone surgical excision (n = 102) or mammographic surveillance after biopsy for at least 24 months (median, 38 months; n = 55). Mammographic lesion type, lesion size, biopsy guidance method, biopsy device, number of specimens per lesion, and presence of atypical hyperplasia at percutaneous biopsy were retrospectively analyzed. Results were compared with histologic findings at surgery or mammographic findings during surveillance. RESULTS. Carcinoma was found at excision in 28% (8/29) of lesions with associated atypical hyperplasia at percutaneous biopsy and 4% (5/128) of lesions without associated atypia (p < 0.0001). In the latter group, carcinoma was found at excision in 3% (2/60) of masses, 8% (3/40) of architectural distortions, and 0% (0/28) of microcalcification lesions. Malignancy was missed in 9% (5/58) of lesions biopsied with a spring-loaded device and in 0% (0/70) of lesions biopsied with a directional vacuum-assisted device (p = 0.01); and in 8% (5/60) of lesions sampled with less than 12 specimens per lesion and 0% (0/68) sampled with 12 or more specimens (p = 0.015). Lesion type, maximal lesion diameter, and type of imaging guidance (stereotactic or sonographic) were not significant factors in determining the presence of malignancy. CONCLUSION. Diagnosis of radial scar based on core needle biopsy is likely to be reliable when there is no associated atypical hyperplasia at percutaneous biopsy, when the biopsy includes at least 12 specimens, and when mammographic findings are reconciled with histologic findings. When the lesion diagnosed by core needle biopsy as radial scar does not meet these criteria, excisional biopsy is indicated.

AB - OBJECTIVE. This study was conducted to evaluate the outcome of cases of radial scar diagnosed by percutaneous core needle biopsy. MATERIALS AND METHODS. Of 198 nonpalpable lesions diagnosed with radial scars found at core needle biopsy, 157 lesions constituting the study group had undergone surgical excision (n = 102) or mammographic surveillance after biopsy for at least 24 months (median, 38 months; n = 55). Mammographic lesion type, lesion size, biopsy guidance method, biopsy device, number of specimens per lesion, and presence of atypical hyperplasia at percutaneous biopsy were retrospectively analyzed. Results were compared with histologic findings at surgery or mammographic findings during surveillance. RESULTS. Carcinoma was found at excision in 28% (8/29) of lesions with associated atypical hyperplasia at percutaneous biopsy and 4% (5/128) of lesions without associated atypia (p < 0.0001). In the latter group, carcinoma was found at excision in 3% (2/60) of masses, 8% (3/40) of architectural distortions, and 0% (0/28) of microcalcification lesions. Malignancy was missed in 9% (5/58) of lesions biopsied with a spring-loaded device and in 0% (0/70) of lesions biopsied with a directional vacuum-assisted device (p = 0.01); and in 8% (5/60) of lesions sampled with less than 12 specimens per lesion and 0% (0/68) sampled with 12 or more specimens (p = 0.015). Lesion type, maximal lesion diameter, and type of imaging guidance (stereotactic or sonographic) were not significant factors in determining the presence of malignancy. CONCLUSION. Diagnosis of radial scar based on core needle biopsy is likely to be reliable when there is no associated atypical hyperplasia at percutaneous biopsy, when the biopsy includes at least 12 specimens, and when mammographic findings are reconciled with histologic findings. When the lesion diagnosed by core needle biopsy as radial scar does not meet these criteria, excisional biopsy is indicated.

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