MANAGEMENT OF RADIAL SCAR AND COMPLEX SCLEROSING LESIONS OF THE BREAST: TO EXCISE OR NOT TO EXCISE? A RETROSPECTIVE STUDY nicholas.zakem@mail.mcgill.ca

225-06

MANAGEMENT OF RADIAL SCAR AND COMPLEX SCLEROSING LESIONS OF THE BREAST: TO EXCISE OR NOT TO EXCISE? A RETROSPECTIVE STUDY

5

 

 

 

 

Canada

Oral or Poster

Radial scars (RS) and complex sclerosing lesions (CSL) are benign breast lesions often found incidentally on imaging. While historically excised surgically, recent data suggest conservative management may be appropriate. This study evaluated upgrade rates of excised RS/CSL and progression of non-excised lesions, and examined predictors of these outcomes.

We retrospectively reviewed the Breast Biopsy Database at the McGill University Health Centre for adult women diagnosed with RS or CSL on image-guided core needle biopsy between October 2010 and February 2024. Outcomes included upgrade or progression to invasive carcinoma (IC), non-invasive carcinoma (NIC), or high-risk lesion (HRL).

Among 159 patients, 44 (27.7%) underwent surgery and 115 (72.3%) were managed non-operatively. In the surgical group, upgrades occurred in 4.6% (IC) and 11.4% (NIC), with HRL in 18.2%. In the non-surgical group, 3.5% progressed to IC, none to NIC, and 1.7% to HRL. No significant predictors of upgrade were identified in the surgical group. In the non-surgical group, calcifications were significantly associated with progression (OR 5.69, 95% CI 1.20–36.43). All cases lacked atypia. A palpable mass increased odds of surgery (OR 15.76, 95% CI 1.82–226.70).

Our study demonstrates that both surgical excision and non-surgical management of RS and CSL are associated with low upgrade and progression rates, particularly to invasive carcinoma. These findings suggest that conservative management, with careful monitoring of radiologic features like calcifications, is a viable option for many patients and could help shape future management guidelines.