Radial Scar

Definition

• Characterized microscopically by a Star-like lesion fibroelastic core with radiating ducts and lobules.
  • Stromal fibrosis and ductal hyperplasia.
• Common, benign
• May be associated with increased Ca risk
  • DCIS +/- IDC, 2 x risk in associated breast

Types

• Radial Scar (< 1cm)
• Complex Sclerosing Lesion (> 1cm)
  • Background for development of atypical epithelial proliferations including ADH (Atypical Ductal Hyperplasia) and DCIS
  • Increased risk of malignancy
  • Difficult to distinguish from malignancy – associated with malignancy ~ 10%
  • Open excision recommended

Management

• Traditionally radial scar and complex sclerosing lesion were surgical excised always
  • Based on series showing that 8 to 17 percent of surgical specimens at subsequent excision are positive for malignancy
  • Contemporary series suggest the presence of undiagnosed cancer is much lower, with upgrade rates in the range of 0.6 to 3.6 percent
• American Society of Breast Surgeons state
  • “Should be excised”
  • Although imaging follow-up is reasonable for small, image-detected radial scars that are completely removed or well-sampled with large-gauge devices and in the setting of imaging-pathology concordance