Evaluation of Benign Breast Diseases With or Without Atypical Epithelial Hyperplasia Accompanying Radial Scars.

Original Article Eur J Breast Health 2023; 19(2): 166-171 DOI: 10.4274/ejbh.galenos.2023.2022-10-4 Evaluation of Benign Breast Diseases With or Without Atypical Epithelial Hyperplasia Accompanying Radial Scars Zeliha Turkyilmaz1, Elif Sarisik2, Enver Ozkurt3, Mustafa Tukenmez3, Selman Emiroglu3, Semen Onder4, Ravza Yilmaz5, Mahmut Muslumanoglu3, Abdullah Igci3, Vahit Ozmen3, Baris Emiroglu3, Neslihan Cabioglu3 Department of General Surgery, Trakya University Faculty of Medicine, Edirne, Turkey Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey 3 Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey 4 Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey 5 Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey 1 2 ABSTRACT Objective: A radial scar (RS) is a benign breast lesion (BBL) that has an obscure etiology. RS is easily confused with breast carcinoma and therefore correct identification radiologically and pathologically is important. The aim of this study was to determine the incidence of atypical lesions by evaluating RS detected with BBL and to investigate whether atypia and RS are related to their characteristics. Materials and Methods: A total of 1.370 patients with a diagnosis of BBL postoperatively in a single department were analyzed retrospectively. Forty-six confirmed RS/complex sclerosing lesion (CSL) cases were selected. The demographic and clinical characteristics of the patients and the relationship between RS and other BBL were evaluated. In addition, the relationship between RS/CSL and the presence of atypia was interpreted. Results: The mean age was 45.17±8.72 years. Spiculated lesion (34.8%) on mammography and microcalcification (37%) on histopathological examination were the most common features. The most common BBL accompanying RS/CSL was adenosis. Atypical epithelial hyperplasia (AEH) was presented in 15 (32.6%) of those diagnosed with RS. Although all patients were benign, the frequency of AEH accompanying RS was found to be significantly higher. The mean size of RS was 10.8±8.4 mm (2-30 mm). The size of RS/CSL was not significantly associated with atypia. Conclusion: RS/CSLs usually present as suspicious lesions that must be distinguished radiologically from malignancy. However RS, which can be present with malign breast lesions, can be also seen with all BBL. Therefore, core biopsy and/or excisional biopsy continue to be important for definitive histopathological diagnosis. Keywords: Radial scar; complex sclerosing lesion; benign breast lesions; spiculated lesion Cite this article as: Turkyilmaz Z, Sarisik E, Ozkurt E, Tukenmez M, Emiroglu S, Emiroglu B, Onder S, Yilmaz R, Muslumanoglu M, Igci A, Ozmen V, Cabioglu N. Evaluation of Benign Breast Diseases With or Without Atypical Epithelial Hyperplasia Accompanying Radial Scars. Eur J Breast Health 2023; 19(2): 166-171 Key Points • Radial scar (RS) often has a spicule appearance mimicking breast carcinoma on mammography, so the definitive diagnosis of the lesion with mammography is difficult. • The high incidence of atypical epithelial hyperplasia accompanying RS in the study suggests that RS is strongly associated with atypia. • The follow up of RS without atypia requires a multidisciplinary approach. Introduction Radial scar (RS) and complex sclerosing lesion (CSL) may be confusing, benign breast lesions (BBL). RS is a proliferative BBL that includes central sclerosis. Distortion and pseudo-infiltrative appearance have been confused with carcinoma (1). When the size is smaller than 1 cm, the lesion is termed RS, whereas, if it is bigger than 1 cm, it is 166 Corresponding Author: Zeliha Turkyilmaz; designated a CSL (1, 2). Small lesions usually present as incidental microscopic findings but the mammographic findings of large lesions are typical (2, 3). The incidence of RS and CSL is reported to be 0.03– 0.09% in all core needle biopsies (CNB) (4, 5). RS pathogenesis is not exactly clear. Inflammatory process, chronic ischemia, previous trauma and surgical operations may all play a role in the pathogenesis of RS Received: 19.10.2022 Accepted: 28.02.2023 Available Online Date: 01.04.2023 ©Copyright 2023 by the Turkish Federation of Breast Diseases Societies / European Journal of Breast Health published by Galenos Publishing House. Turkyilmaz et al. Radial Scars (6). RS is characterized by a central area of fibroelastosis with radiating ducts and lobules. These ducts and lobules have the appearance of spicules on mammography, which often mimics breast carcinoma (1, 7). Therefore, it is difficult for a definitive mammographic diagnosis of this lesion (6, 7). The results of studies examining the relationship between breast cancer and RS are controversial. Currently, it is unclear whether RS/CSL only act as an independent risk factor in increasing breast cancer or are in themselves premalignant (6, 8). Although RS/ CSL is mostly associated with malignancy by clinicans, it can frequently be seen with various BBLs. Proliferative BBLs, with or without atypia, may accompany RS (5, 6, 8). Table 1. Demographic and clinical characteristics of patients n Age % 45.17±8.72 (22–61) Age groups 20-30 3 6.5 31-40 8 17.4 41-50 21 45.7 50+ 14 30.4 Premenopausal 31 67.4 The aim of this study was to determine the benefits of imaging modalities and core needle biopsy and to investigate the frequency of benign lesions in the breast associated with RS. Furthermore, the association of RS with or without atypical BBL was assessed. Postmenopausal 15 32.6 Used oral contraceptives 10 21.7 Materials and Methods Family history of breast cancer 7 15.2 Age at menarche (year) 13.5±1.4 Lactation period (month) 22.72±19.31 Between 1995-2015, 1.370 operated cases were diagnosed with BBL and retrospectively analyzed at Istanbul University, Faculty of Medicine Surgery, Department C Clinical Services. Forty-nine cases with histopathology confirming cases of RS or CSL were selected. As the aim was to consider etiologically non-traumatic and idiopathic RS in patients without history of breast operation, 3 of 49 (6.1%) cases that had excisional biopsies performed on the same breast previously were excluded. Demographic and clinical characteristics of the remaining 46 patients including age, menopausal status, age at menarche, lactation period, number of births, family history of cancer, oral contraceptive use, hormonal therapy, complaint, palpability of lesions, and side of lesions were evaluated. Ultrasonography, mammography, and magnetic resonance imaging (MRI) results were also evaluated by size and Breast Imaging Reporting and Data System (BI-RADS) score. If the lesion was 1.0 cm or less, the lesion was designated RS and if greater than 1.0 cm it was defined as CSL. We gathered and reviewed follow-up reports in order to examine the risk of dev (...truncated)