Radial scar (RS): Benign proliferative lesion with central fibroelastosis and spiculated appearance radiographically and histologically
Complex sclerosing lesion (CSL): RS > 1 cm in size
Radial sclerosing lesion (RSL): Refers to both RS & CSL
Incidental radial scar: Microscopic, entirely contained within core biopsy specimen as part of biopsy targeted to finding other than distortion or spiculated mass, e.g., adjacent to targeted calcifications
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Image-Guided Biopsy
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Alshafeiy TI et al: Outcome of architectural distortion detected only at breast tomosynthesis versus 2D mammography. Radiology. 288(1):38-46, 2018
Calhoun BC: Core Needle biopsy of the breast: an evaluation of contemporary data. Surg Pathol Clin. 11(1):1-16, 2018
Chou WYY et al: Radial scar on image-guided breast biopsy: is surgical excision necessary? Breast Cancer Res Treat. 170(2):313-20, 2018
Nakhlis F et al: Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: low risk of carcinoma on excision in cases with clinical and imaging concordance. Breast J. 24(2):133-8, 2018
Speer ME et al: High risk breast lesions identified on MRI-guided vacuum assisted needle biopsy: outcome of surgical excision and imaging follow-up. Br J Radiol. 20180300, 2018
Bahl M et al: Pathologic outcomes of architectural distortion on digital 2D versus tomosynthesis mammography. AJR Am J Roentgenol. 209(5):1162-7, 2017
Cohen MA and Newell MS: Radial scars of the breast encountered at core biopsy: review of histologic, imaging, and management considerations. AJR Am J Roentgenol. 209(5):1168-77, 2017
Ferreira AI et al: Radial scar of the breast: Is it possible to avoid surgery? Eur J Surg Oncol. 43(7):1265-72, 2017
Mesa-Quesada J et al: Radial scars without atypia in percutaneous biopsy specimens: can they obviate surgical biopsy? Radiologia. 59(6):523-30, 2017
Racz JM et al: Challenging atypical breast lesions including flat epithelial atypia, radial scar, and intraductal papilloma. Ann Surg Oncol. 24(10):2842-7, 2017
Donaldson AR et al: Radial scars diagnosed on breast core biopsy: frequency of atypia and carcinoma on excision and implications for management. Breast. 30:201-7, 2016
Hou Y et al: Surgical excision outcome after radial scar without atypical proliferative lesion on breast core needle biopsy: a single institutional analysis. Ann Diagn Pathol. 21:35-8, 2016
Kalife ET et al: Clinical and radiologic follow-up study for biopsy diagnosis of radial scar/radial sclerosing lesion without other atypia. Breast J. 22(6):637-44, 2016
Leong RY et al: Radial scar at percutaneous breast biopsy that does not require surgery. J Am Coll Surg. 223(5):712-6, 2016
Li Z et al: Pathologic findings of follow-up surgical excision for radial scar on breast core needle biopsy. Hum Pathol. 48:76-80, 2016
Park VY et al: Mammographically occult asymptomatic radial scars/complex sclerosing lesions at ultrasonography-guided core needle biopsy: follow-up can be recommended. Ultrasound Med Biol. 42(10):2367-71, 2016
Rageth CJ et al: First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 159(2):203-13, 2016
Matrai C et al: Advocating Nonsurgical management of patients with small, incidental radial scars at the time of needle core biopsy: a study of 77 cases. Arch Pathol Lab Med. 139(9):1137-42, 2015
Nassar A et al: Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution. Ann Diagn Pathol. 19(1):24-8, 2015
Miller CL et al: Surgical excision of radial scars diagnosed by core biopsy may help predict future risk of breast cancer. Breast Cancer Res Treat. 145(2):331-8, 2014
Bianchi S et al: Radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy: analysis of 49 cases from a single-centre and review of the literature. Breast. 21(2):159-64, 2012
Heller SL et al: Imaging features and management of high-risk lesions on contrast-enhanced dynamic breast MRI. AJR Am J Roentgenol. 198(2):249-55, 2012
Krishnamurthy S et al: Multidisciplinary considerations in the management of high-risk breast lesions. AJR Am J Roentgenol. 198(2):W132-40, 2012
Lee KA et al: Risk of malignancy when microscopic radial scars and microscopic papillomas are found at percutaneous biopsy. AJR Am J Roentgenol. 198(2):W141-5, 2012
Linda A et al: Magnetic resonance imaging of radial sclerosing lesions (radial scars) of the breast. Eur J Radiol. 81(11):3201-7, 2012
Linda A et al: Nonsurgical management of high-risk lesions diagnosed at core needle biopsy: can malignancy be ruled out safely with breast MRI? AJR Am J Roentgenol. 198(2):272-80, 2012
Londero V et al: High-risk breast lesions at imaging-guided needle biopsy: usefulness of MRI for treatment decision. AJR Am J Roentgenol. 199(2):W240-50, 2012
Morgan C et al: The radial scar of the breast diagnosed at core needle biopsy. Proc (Bayl Univ Med Cent). 25(1):3-5, 2012
Tabar L et al: Teaching Atlas of Mammography. 4th ed. Stuttgart, Germany: Thieme, 2012
Crystal P et al: High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted? Eur Radiol. 21(3):582-9, 2011
Osborn G et al: A review of needle core biopsy diagnosed radial scars in the Welsh Breast Screening Programme. Ann R Coll Surg Engl. 93(2):123-6, 2011
Rajan S et al: Conservative management of screen-detected radial scars: role of mammotome excision. J Clin Pathol. 64(1):65-8, 2011
Resetkova E et al: Management of radial sclerosing lesions of the breast diagnosed using percutaneous vacuum-assisted core needle biopsy: recommendations for excision based on seven years' of experience at a single institution. Breast Cancer Res Treat. 127(2):335-43, 2011
Linda A et al: Radial scars without atypia diagnosed at imaging-guided needle biopsy: how often is associated malignancy found at subsequent surgical excision, and do mammography and sonography predict which lesions are malignant? AJR Am J Roentgenol. 194(4):1146-51, 2010
Pediconi F et al: Role of breast MR imaging for predicting malignancy of histologically borderline lesions diagnosed at core needle biopsy: prospective evaluation. Radiology. 257(3):653-61, 2010
Sohn VY et al: The treatment of radial scars in the modern era--surgical excision is not required. Am Surg. 76(5):522-5, 2010
Perfetto F et al: Adjunctive diagnostic value of MRI in the breast radial scar. Radiol Med. 114(5):757-70, 2009
Berg JC et al: Breast cancer risk in women with radial scars in benign breast biopsies. Breast Cancer Res Treat. 108(2):167-74, 2008
Manfrin E et al: Risk of neoplastic transformation in asymptomatic radial scar. Analysis of 117 cases. Breast Cancer Res Treat. 107(3):371-7, 2008
Douglas-Jones AG et al: Radial scar lesions of the breast diagnosed by needle core biopsy: analysis of cases containing occult malignancy. J Clin Pathol. 60(3):295-8, 2007
Doyle EM et al: Radial scars/complex sclerosing lesions and malignancy in a screening programme: incidence and histological features revisited. Histopathology. 50(5):607-14, 2007
Becker L et al: Management of radial scars found at percutaneous breast biopsy. Can Assoc Radiol J. 57(2):72-8, 2006
López-Medina A et al: Radial scars diagnosed at stereotactic core-needle biopsy: surgical biopsy findings. Eur Radiol. 16(8):1803-10, 2006
Sanders ME et al: Interdependence of radial scar and proliferative disease with respect to invasive breast carcinoma risk in patients with benign breast biopsies. Cancer. 106(7):1453-61, 2006
Pediconi F et al: Radial scars of the breast: contrast-enhanced magnetic resonance mammography appearance. Breast J. 11(1):23-8, 2005
Brodie C et al: Fourteen-gauge needle core biopsy of mammographically evident radial scars: is excision necessary? Cancer. 100(3):652-3; author reply 653-4, 2004
Cawson JN et al: Fourteen-gauge needle core biopsy of mammographically evident radial scars: is excision necessary? Cancer. 97(2):345-51, 2003
Brenner RJ et al: Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? AJR Am J Roentgenol. 179(5):1179-84, 2002
Alvarado-Cabrero I et al: Neoplastic and malignant lesions involving or arising in a radial scar: a clinicopathologic analysis of 17 cases. Breast J. 6(2):96-102, 2000
Cohen MA et al: Role of sonography in evaluation of radial scars of the breast. AJR Am J Roentgenol. 174(4):1075-8, 2000
Kirwan SE et al: Multiple 14G stereotactic core biopsies in the diagnosis of mammographically detected stellate lesions of the breast. Clin Radiol. 55(10):763-6, 2000
Philpotts LE et al: Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology; 216:831-7, 2000
Reynolds HE: Core needle biopsy of challenging benign breast conditions: a comprehensive literature review. AJR Am J Roentgenol. 174(5):1245-50, 2000
Hassell P et al: Radial sclerosing lesions of the breast: mammographic and pathologic correlation. Can Assoc Radiol J. 50(6):370-5, 1999
Jackman RJ et al: Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up. Radiology. 210(3):799-805, 1999
Jacobs TW et al: Radial scars in benign breast-biopsy specimens and the risk of breast cancer. N Engl J Med. 340(6):430-6, 1999
Frouge C et al: Mammographic lesions suggestive of radial scars: microscopic findings in 40 cases. Radiology. 195(3):623-5, 1995
Sloane JP et al: Carcinoma and atypical hyperplasia in radial scars and complex sclerosing lesions: importance of lesion size and patient age. Histopathology. 23(3):225-31, 1993
Orel SG et al: Radial scar with microcalcifications: radiologic-pathologic correlation. Radiology. 183(2):479-82, 1992
Adler DD et al: Radial sclerosing lesion of the breast: mammographic features. Radiology. 176(3):737-40, 1990
Nielsen M et al: An autopsy study of radial scar in the female breast. Histopathology. 9(3):287-95, 1985
Radial scar (RS): Benign proliferative lesion with central fibroelastosis and spiculated appearance radiographically and histologically
Complex sclerosing lesion (CSL): RS > 1 cm in size
Radial sclerosing lesion (RSL): Refers to both RS & CSL
Incidental radial scar: Microscopic, entirely contained within core biopsy specimen as part of biopsy targeted to finding other than distortion or spiculated mass, e.g., adjacent to targeted calcifications
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Image-Guided Biopsy
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Alshafeiy TI et al: Outcome of architectural distortion detected only at breast tomosynthesis versus 2D mammography. Radiology. 288(1):38-46, 2018
Calhoun BC: Core Needle biopsy of the breast: an evaluation of contemporary data. Surg Pathol Clin. 11(1):1-16, 2018
Chou WYY et al: Radial scar on image-guided breast biopsy: is surgical excision necessary? Breast Cancer Res Treat. 170(2):313-20, 2018
Nakhlis F et al: Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: low risk of carcinoma on excision in cases with clinical and imaging concordance. Breast J. 24(2):133-8, 2018
Speer ME et al: High risk breast lesions identified on MRI-guided vacuum assisted needle biopsy: outcome of surgical excision and imaging follow-up. Br J Radiol. 20180300, 2018
Bahl M et al: Pathologic outcomes of architectural distortion on digital 2D versus tomosynthesis mammography. AJR Am J Roentgenol. 209(5):1162-7, 2017
Cohen MA and Newell MS: Radial scars of the breast encountered at core biopsy: review of histologic, imaging, and management considerations. AJR Am J Roentgenol. 209(5):1168-77, 2017
Ferreira AI et al: Radial scar of the breast: Is it possible to avoid surgery? Eur J Surg Oncol. 43(7):1265-72, 2017
Mesa-Quesada J et al: Radial scars without atypia in percutaneous biopsy specimens: can they obviate surgical biopsy? Radiologia. 59(6):523-30, 2017
Racz JM et al: Challenging atypical breast lesions including flat epithelial atypia, radial scar, and intraductal papilloma. Ann Surg Oncol. 24(10):2842-7, 2017
Donaldson AR et al: Radial scars diagnosed on breast core biopsy: frequency of atypia and carcinoma on excision and implications for management. Breast. 30:201-7, 2016
Hou Y et al: Surgical excision outcome after radial scar without atypical proliferative lesion on breast core needle biopsy: a single institutional analysis. Ann Diagn Pathol. 21:35-8, 2016
Kalife ET et al: Clinical and radiologic follow-up study for biopsy diagnosis of radial scar/radial sclerosing lesion without other atypia. Breast J. 22(6):637-44, 2016
Leong RY et al: Radial scar at percutaneous breast biopsy that does not require surgery. J Am Coll Surg. 223(5):712-6, 2016
Li Z et al: Pathologic findings of follow-up surgical excision for radial scar on breast core needle biopsy. Hum Pathol. 48:76-80, 2016
Park VY et al: Mammographically occult asymptomatic radial scars/complex sclerosing lesions at ultrasonography-guided core needle biopsy: follow-up can be recommended. Ultrasound Med Biol. 42(10):2367-71, 2016
Rageth CJ et al: First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 159(2):203-13, 2016
Matrai C et al: Advocating Nonsurgical management of patients with small, incidental radial scars at the time of needle core biopsy: a study of 77 cases. Arch Pathol Lab Med. 139(9):1137-42, 2015
Nassar A et al: Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution. Ann Diagn Pathol. 19(1):24-8, 2015
Miller CL et al: Surgical excision of radial scars diagnosed by core biopsy may help predict future risk of breast cancer. Breast Cancer Res Treat. 145(2):331-8, 2014
Bianchi S et al: Radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy: analysis of 49 cases from a single-centre and review of the literature. Breast. 21(2):159-64, 2012
Heller SL et al: Imaging features and management of high-risk lesions on contrast-enhanced dynamic breast MRI. AJR Am J Roentgenol. 198(2):249-55, 2012
Krishnamurthy S et al: Multidisciplinary considerations in the management of high-risk breast lesions. AJR Am J Roentgenol. 198(2):W132-40, 2012
Lee KA et al: Risk of malignancy when microscopic radial scars and microscopic papillomas are found at percutaneous biopsy. AJR Am J Roentgenol. 198(2):W141-5, 2012
Linda A et al: Magnetic resonance imaging of radial sclerosing lesions (radial scars) of the breast. Eur J Radiol. 81(11):3201-7, 2012
Linda A et al: Nonsurgical management of high-risk lesions diagnosed at core needle biopsy: can malignancy be ruled out safely with breast MRI? AJR Am J Roentgenol. 198(2):272-80, 2012
Londero V et al: High-risk breast lesions at imaging-guided needle biopsy: usefulness of MRI for treatment decision. AJR Am J Roentgenol. 199(2):W240-50, 2012
Morgan C et al: The radial scar of the breast diagnosed at core needle biopsy. Proc (Bayl Univ Med Cent). 25(1):3-5, 2012
Tabar L et al: Teaching Atlas of Mammography. 4th ed. Stuttgart, Germany: Thieme, 2012
Crystal P et al: High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted? Eur Radiol. 21(3):582-9, 2011
Osborn G et al: A review of needle core biopsy diagnosed radial scars in the Welsh Breast Screening Programme. Ann R Coll Surg Engl. 93(2):123-6, 2011
Rajan S et al: Conservative management of screen-detected radial scars: role of mammotome excision. J Clin Pathol. 64(1):65-8, 2011
Resetkova E et al: Management of radial sclerosing lesions of the breast diagnosed using percutaneous vacuum-assisted core needle biopsy: recommendations for excision based on seven years' of experience at a single institution. Breast Cancer Res Treat. 127(2):335-43, 2011
Linda A et al: Radial scars without atypia diagnosed at imaging-guided needle biopsy: how often is associated malignancy found at subsequent surgical excision, and do mammography and sonography predict which lesions are malignant? AJR Am J Roentgenol. 194(4):1146-51, 2010
Pediconi F et al: Role of breast MR imaging for predicting malignancy of histologically borderline lesions diagnosed at core needle biopsy: prospective evaluation. Radiology. 257(3):653-61, 2010
Sohn VY et al: The treatment of radial scars in the modern era--surgical excision is not required. Am Surg. 76(5):522-5, 2010
Perfetto F et al: Adjunctive diagnostic value of MRI in the breast radial scar. Radiol Med. 114(5):757-70, 2009
Berg JC et al: Breast cancer risk in women with radial scars in benign breast biopsies. Breast Cancer Res Treat. 108(2):167-74, 2008
Manfrin E et al: Risk of neoplastic transformation in asymptomatic radial scar. Analysis of 117 cases. Breast Cancer Res Treat. 107(3):371-7, 2008
Douglas-Jones AG et al: Radial scar lesions of the breast diagnosed by needle core biopsy: analysis of cases containing occult malignancy. J Clin Pathol. 60(3):295-8, 2007
Doyle EM et al: Radial scars/complex sclerosing lesions and malignancy in a screening programme: incidence and histological features revisited. Histopathology. 50(5):607-14, 2007
Becker L et al: Management of radial scars found at percutaneous breast biopsy. Can Assoc Radiol J. 57(2):72-8, 2006
López-Medina A et al: Radial scars diagnosed at stereotactic core-needle biopsy: surgical biopsy findings. Eur Radiol. 16(8):1803-10, 2006
Sanders ME et al: Interdependence of radial scar and proliferative disease with respect to invasive breast carcinoma risk in patients with benign breast biopsies. Cancer. 106(7):1453-61, 2006
Pediconi F et al: Radial scars of the breast: contrast-enhanced magnetic resonance mammography appearance. Breast J. 11(1):23-8, 2005
Brodie C et al: Fourteen-gauge needle core biopsy of mammographically evident radial scars: is excision necessary? Cancer. 100(3):652-3; author reply 653-4, 2004
Cawson JN et al: Fourteen-gauge needle core biopsy of mammographically evident radial scars: is excision necessary? Cancer. 97(2):345-51, 2003
Brenner RJ et al: Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? AJR Am J Roentgenol. 179(5):1179-84, 2002
Alvarado-Cabrero I et al: Neoplastic and malignant lesions involving or arising in a radial scar: a clinicopathologic analysis of 17 cases. Breast J. 6(2):96-102, 2000
Cohen MA et al: Role of sonography in evaluation of radial scars of the breast. AJR Am J Roentgenol. 174(4):1075-8, 2000
Kirwan SE et al: Multiple 14G stereotactic core biopsies in the diagnosis of mammographically detected stellate lesions of the breast. Clin Radiol. 55(10):763-6, 2000
Philpotts LE et al: Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology; 216:831-7, 2000
Reynolds HE: Core needle biopsy of challenging benign breast conditions: a comprehensive literature review. AJR Am J Roentgenol. 174(5):1245-50, 2000
Hassell P et al: Radial sclerosing lesions of the breast: mammographic and pathologic correlation. Can Assoc Radiol J. 50(6):370-5, 1999
Jackman RJ et al: Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up. Radiology. 210(3):799-805, 1999
Jacobs TW et al: Radial scars in benign breast-biopsy specimens and the risk of breast cancer. N Engl J Med. 340(6):430-6, 1999
Frouge C et al: Mammographic lesions suggestive of radial scars: microscopic findings in 40 cases. Radiology. 195(3):623-5, 1995
Sloane JP et al: Carcinoma and atypical hyperplasia in radial scars and complex sclerosing lesions: importance of lesion size and patient age. Histopathology. 23(3):225-31, 1993
Orel SG et al: Radial scar with microcalcifications: radiologic-pathologic correlation. Radiology. 183(2):479-82, 1992
Adler DD et al: Radial sclerosing lesion of the breast: mammographic features. Radiology. 176(3):737-40, 1990
Nielsen M et al: An autopsy study of radial scar in the female breast. Histopathology. 9(3):287-95, 1985
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