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Radial Scar at Image-guided Needle Biopsy: Is Excision Necessary?

放射状瘢痕影像引导下穿刺活检:必须手术切除吗?

Conlon N,D'Arcy C,Kaplan JB,Bowser ZL,Cordero A,Brogi E,Corben AD

Abstract

Optimal management of a lesion yielding radial scar (RS) without epithelial atypia on breast biopsy is controversial. In this single-institution study spanning 17 years, 53 patients with this biopsy diagnosis were evaluated in terms of clinical, radiologic, and pathologic features and outcomes. RSs were categorized as either "incidental" or as the "targeted" lesion according to defined criteria. Of 48 patients who underwent surgical excision after a diagnosis of RS on biopsy, only 1 had an "upgrade" diagnosis of malignancy (2%). No "incidental" RS was associated with the presence of malignancy on surgical excision. Meta-analysis of 20 RS excision studies demonstrated an overall upgrade rate of 10.4%, with a higher rate in patients with a diagnosis of RS with atypia (26%). The upgrade rate for RS without atypia was 7.5% overall. The lower rate of upgrade to malignancy in this study (2%) is likely related to the thorough radiologic-pathologic review undertaken. In the setting of multidisciplinary agreement and careful radiologic-pathologic correlation, it may be appropriate for patients with a biopsy diagnosis of RS without atypia to forego surgical excision in favor of imaging follow-up.

摘要

对于乳腺活检诊断为不伴上皮异型增生的放射状瘢痕(RS),其理想的处理方式是有争议的。在这篇单机构跨越17年的研究中,收集了53例活检诊断RS的病例,复习其临床表现、影像学改变、病理特征和预后信息。按照定义的标准,将RS分为“偶然发现”或“目标性”病变。48例活检诊断为RS后接受手术切除的患者中,只有1例术后“升级”为恶性肿瘤(2%)。“偶然发现”的RS手术切除后没有恶性发现。 20例RS手术切除标本Meta分析显示总体升级率为10.4%,其中诊断为伴有异型的RS升级比率较高(26%)。诊断为RS无异型的总体升级率为7.5%。本研究中升级到恶性肿瘤的比率较低(2%)可能与所采用的详尽的影像-病理学检查相关。在多学科协作和细致的影像-病理学检查帮助下,活检诊断为不伴上皮异型的RS患者选择放弃手术而在影像学指导下随访,可能是比较合适的。
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