Can ultrasound reliably localise radial scars (RS)/complex sclerosing lesions (CSL) prior to excision biopsy?

Traditionally, mammography has been used to localise radial scars (RS)/complex sclerosing lesions (CSL) prior to excision biopsy. Our aim was to evaluate the adequacy of pre-operative ultrasound. Fifty-eight consecutive women (age range 36–72 years) who had a definitive diagnosis at excision biopsy of RS/CSL were identified between January 1997 and January 2002. Twenty-eight patients underwent pre-operative ultrasound (US) localisation and 30 mammographic (MG) localisation (29 wire and one surface marker). The size of the lesion, weight of specimen and adequacy of excision were recorded. Successful localisation was achieved in all patients. In patients with an entirely benign RS/CSL the median size of the lesion was 14.5 mm (range 9–20 mm) in the US localisation group and 11 mm (range 4–20 mm) in the MG localisation group. Median weight of the specimens was 16 g (range 6–65 g) in the US group and 15 g (range 7–45 g) in the MG group. Eight (35%) of 23 biopsies were greater than 20 g in the US group compared with five (19%) of 26 in the MG group. By Fisher's exact test there was no significant difference (P = 0.3320). In patients with malignant disease associated with a RS/CSL, re-excision was required in one of three in the US group and two of four in the MG group.

Pre-operative US localisation compares favourably with MG techniques for excision biopsy of RS/CSL.