All stellate lesions seen on breast screening mammograms should be excised

The purpose of our study (Fasih T et al.: "All radial scars/complex sclerosing lesions seen on breast screening mammograms should be excised", Eur J Surg Oncol. 2005 Dec;31(10):1125-8) was to determine the incidence of carcinoma, both insitu and invasive, and atypical ductal hyperplasia (ADH) in radial scars (RS) and complex sclerosing lesions (CSL) detected in breast screening patients, and to find out whether excision is justified in all cases.  Women taking part in the UK NHS breast cancer-screening programme from 1989 to 2002 were included in this study.

Mammograms and FNA, where performed did not correspond to the underlying malignancies in majority of cases.  All patients had subsequent excision biopsies when124 lesions were identified as RS or CSL. The median age of these patients was 58 years.

Of these 124 patients 82 (66%) had pure RS/CSL. Twenty two (18%) patients had associated ADH and 20 (16%) patients had either insitu or invasive carcinoma along with RS.

We therefore conclude that RS/CSL are associated with increased risk of malignant lesions^1-5 and therefore a spiculate lesion suggestive of radial scar at mammography should be excised. It is important that in mammographically suspected RS/CSL the patient should be made aware preoperatively of the potential for malignant pathology.  With the advent of the mammotome, many of these lesions can be removed in the breast radiology department and if the histology shows associated DCIS or invasive cancer then further excision can be undertaken.^6,7.  

Bibliographical references: 

1.Kennedy M, Masterson AV. ‘Pathology and clinical relevance of radial scars: a review. Journal of Clinical Pathology. 56(10):721-4,2003.

2.Jackman RJ, Nowels KW, Rodriguez-Soto J, Marzoni FA Jr,Finkelstein SI, Shepard MJ. stereotactic, automated, large core needle biopsy on non- palpable breast lesions: false negative and histologic underestimation rates  after long term follow up. Radiology 1999; 210; 799-805.

3.Frouge C, Tristant H, Guinebretiere JM, Meunier M, Contesso G,  Di Paola R, Blery M. Mammographic lesions suggestive of radial scars: microscopic findings in 40cases. Radiology 1995; 195: 623-5.

4.Sloane JP, Mayers MM. Carcinoma and atypical hyperplasia in radial scars and complex sclerosing lesions: importance of lesion size and patient age. Histopathology 1993; 23: 225-31.

5.Cawson JN, Malara F, Kavanagh A, Hill P, Balasubramanium G, Henderson M. Fourteen-gauge needle core biopsy of mammographically evident radial scars. Is excision necessary? Cancer 2003; 97: 345-51.

6. Mariotti C, Feliciotti F, Baldarelli M, Serri L, Santinelli A, Fabris G, et al +. ‘Digital stereotactic biopsies for nonpalpable breast lesion’ Surg Endosc.17 (6): 911-7,2003.

7.Diebold T, Jacobi V, Krapfl E, von Minckwitz G, Solbach C, Ballenberger et al+. ‘The role of stereotactic 11 G vacuum biopsy for clarification of B1-RADS IV findings in mammography.’ Rofo175 (4) 489-94,2003

Tarannum Fasih

Royal Victoria Infirmary, Newcastle upon Tyne, UK