ARRS 2022 Abstracts

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1909. Radial Scar Management: Update After 10 Years of Digital Breast Tomosynthesis (DBT)
Authors * Denotes Presenting Author
  1. Reni Butler *; Yale School of Medicine
  2. Melissa Durand; Yale School of Medicine
  3. Maryam Etesami; Yale School of Medicine
  4. Susan Marlatt; Yale School of Medicine
  5. Kiran Sheikh; Yale School of Medicine
  6. Laura Sheiman; Yale School of Medicine
  7. Liane Philpotts; Yale School of Medicine
Objective:
This study aims to evaluate the likelihood of malignant upgrade of radial scars (RS) and complex sclerosing lesions (CSL) diagnosed at core needle biopsy (CNB) in the first 10 years after implementation of digital breast tomosynthesis (DBT)

Materials and Methods:
Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act (HIPAA)-compliant protocol. Medical records of patients diagnosed with RS/CSL at our institution in the 10 years since adoption of DBT were retrospectively reviewed. We recorded patient age, breast cancer history, and clinical presentation; mammographic, ultrasound and MRI findings; lesion size; CNB imaging guidance, needle gauge, and number of samples; CNB histology; and final pathology at surgical excision or BI-RADS category at =2-year follow-up were reviewed. Upgrade to malignancy at surgical excision or on imaging follow-up was also recorded.

Results:
A total of 282 RS/CSL diagnosed as the primary histologic finding at CNB between 8/1/2011 and 7/31/2021 were identified; 61.3% (173/282) were surgically excised, 32.3% (91/282) had =24-month imaging follow-up; 6.4% (18/282) without surgical excision and <24-month imaging follow-up were excluded, yielding a study population of 264 RS/CSL. There were 18.2% (48/264) RS/CSL associated with atypia at CNB. The malignant upgrade rate among these lesions was 10.4% (5/48). Upgraded lesions were all detected on screening mammography; two presented with architectural distortion seen only on DBT, one with architectural distortion seen on both 2D mammography and DBT, one with calcifications, and one with an irregular mass with indistinct margins. Most (81.8%, 216/264) were not associated with atypia or malignancy at CNB. The malignant upgrade rate in this group was 0.9% (2/216). The two upgraded lesions were discovered on breast MRI performed for extent of disease patients with newly diagnosed breast cancer with concurrent contralateral invasive carcinoma.

Conclusion:
The incidence of RS/CSL has increased since implementation of DBT. The low upgrade rate of 0.9% for RS/CSL without atypia on CNB suggests that mammographic follow up may be a reasonable alternative to surgical excision for some patients. Given the increased detection of RS/CSL with DBT, it may be clinically desirable to avoid surgery in most patients with RS/CSL without atypia that can be safely followed.