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Outcome of radial scar/complex sclerosing lesion associated with epithelial proliferations with atypia diagnosed on breast core biopsy: results from a multicentric UK-based study
  1. Emad Rakha1,2,
  2. Francisco Beca3,
  3. Mariangela D'Andrea4,
  4. Areeg Abbas1,
  5. William Petrou-Nunn1,
  6. Abeer M Shaaban1,
  7. Aneeshya Kandiyil1,
  8. Samantha Smith5,
  9. Sindhu Menon1,
  10. Somaia Elsheikh1,2,
  11. Maysa E ElSayed2,
  12. Andrew HS Lee1,
  13. Nisha Sharma6
  1. 1Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2Faculty of Medicine, Menoufiya University, Al Minufya, Egypt
  3. 3Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
  4. 4Specialization School in Anatomic Pathology, University of Pavia, Pavia, Italy
  5. 5South Birmingham Breast Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  6. 6Department of Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
  1. Correspondence to Emad Rakha, Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK; Emad.Rakha{at}


Aims The clinical significance of radial scar (RS)/complex sclerosing lesion (CSL) with high-risk lesions (epithelial atypia) diagnosed on needle core biopsy is not well defined. We aimed at assessing the upgrade rate to ductal carcinoma in situ (DCIS) and invasive carcinoma on the surgical excision specimen in a large cohort with RS/CSL associated with atypia.

Methods 157 women with a needle core biopsy diagnosis of a RS/CSL with atypia and follow-up histology were studied. Histological findings, including different forms of the atypical lesions and final histological outcome in the excision specimens, were retrieved and analysed, and the upgrade rates for malignancy and for invasive carcinoma were calculated.

Results 69.43% of the cases were associated with atypical ductal hyperplasia (ADH) or atypia not otherwise classifiable, whereas lobular neoplasia was seen in 21.66%. On final histology, 39 cases were malignant (overall upgrade rate of 24.84%); 12 were invasive and 27 had DCIS. The upgrade differed according to the type of atypia and was highest for ADH (35%). When associated with lobular neoplasia, the upgrade rate was 11.76%. The upgrade rate’s variability was also considerably lower when considering the upgrade to invasive carcinoma alone for any associated lesion.

Conclusions The upgrade rate for ADH diagnosed on needle core biopsy with RS is similar to that of ADH without RS and therefore should be managed similarly. RS associated with lobular neoplasia is less frequently associated with malignant outcome. Most lesions exhibiting some degree of atypia showed a similar upgrade rate to invasive carcinoma. Management of RS should be based on the concurrent atypical lesion.

  • breast core biopsy
  • B3
  • radial scar
  • atypia
  • outcome

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  • ER and FB are joint first authors.

  • ER and FB contributed equally.

  • Handling editor Cheok Soon Lee.

  • Correction notice This paper has been corrected since it was published Online First. The affiliations have been updated.

  • Contributors ER, FB and NS conceived and designed the study. AA, MDA, AMS, AK, SE, SM, SS, WP-N, MEE and ASL acquired the data. ER and FB ran the data analyses and interpreted the results. All authors participated in the manuscript writing. All authors read and approved the final manuscript.

  • Funding While not directly related to this work, FB is supported by the Department of Pathology of the Stanford University School of Medicine Pathology Trainee Mentored Award in Precision Health and - Friends for An Earlier Breast Cancer Test® Medical Research Grant.

  • Competing interests None.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.