Breast Cancer Research and Treatment

, Volume 173, Issue 1, pp 23–29 | Cite as

Rate of radial scars by core biopsy and upgrading to malignancy or high-risk lesions before and after introduction of digital breast tomosynthesis

  • April Phantana-angkool
  • Meghan R. Forster
  • Yancey E. Warren
  • Chad A. Livasy
  • Amy H. Sobel
  • Lakesha M. Beasley
  • Sally J. Trufan
  • Lejla Hadzikadic-Gusic
  • Terry Sarantou
  • Amy E. Voci
  • Deba Sarma
  • Richard L. WhiteJr.Email author



Radial scars (RS) commonly present mammographically as architectural distortions, but these lesions may be associated with non-invasive and invasive breast cancer. Digital breast tomosynthesis (DBT) has resulted in higher detection rates of architectural distortion particularly in patients with dense breast tissue. We hypothesized that rates of clinically relevant lesions confirmed surgically would be lower in patients who received DBT imaging compared with those who received standard digital breast imaging.


We performed a retrospective review of 223 patients diagnosed with pure RS by core biopsy and surgical excision before and after DBT was introduced. The rate of upgrading to malignancy or high-risk lesion was evaluated. Demographics, biopsy type, and histologic data were analyzed. Univariable logistic regression analysis was used to identify variables that may be associated with upgrading.


The rate of identifying RS increased from 0.04–.13% (P < 0.0001) with DBT imaging. The upgrade rate on surgical specimen to invasive or non-invasive cancer was similar before and after DBT; 6% versus 3%, as were findings of a high-risk lesion; 12% versus 22%. No predictive factors were identified for patients upgraded to malignant neoplasms or high-risk lesions.


The likelihood of identifying RS has increased with DBT imaging, but rates of upgrading to a malignant neoplasm or high-risk lesion were similar to those before DBT. Although the rate of upgrading to malignancy after DBT was low, an excisional biopsy should be considered as 22% of patients were upgraded to high-risk lesions. These patients are candidates for chemoprevention and/or high-risk surveillance.


Radial scar Breast cancer Core biopsy Excisional biopsy Upgrade Digital breast tomosynthesis 



We thank Geraldine M Chadwick, AuD, who provided medical writing support on behalf of the Department of Surgery, Carolinas Medical Center.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study has received ethical approval by the Carolinas HealthCare System Institutional Review Board as it satisfies requirements of 45 CFR 46 110, category #5.

Informed consent

This was a retrospective study. For this type of study, formal consent was not required by the IRB.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • April Phantana-angkool
    • 1
  • Meghan R. Forster
    • 1
  • Yancey E. Warren
    • 1
  • Chad A. Livasy
    • 2
  • Amy H. Sobel
    • 3
  • Lakesha M. Beasley
    • 1
  • Sally J. Trufan
    • 4
  • Lejla Hadzikadic-Gusic
    • 1
  • Terry Sarantou
    • 1
  • Amy E. Voci
    • 1
  • Deba Sarma
    • 1
  • Richard L. WhiteJr.
    • 1
    • 5
    Email author
  1. 1.Division of Surgical Oncology, Department of Surgery, Levine Cancer InstituteCarolinas Medical CenterCharlotteUSA
  2. 2.Charlotte Pathology GroupCharlotteUSA
  3. 3.Charlotte RadiologyCharlotteUSA
  4. 4.Department of Cancer BiostatisticsLevine Cancer InstituteCharlotteUSA
  5. 5.Division of Surgical Oncology, Department of Surgery, Levine Cancer InstituteCarolinas Medical CenterCharlotteUSA

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