Role of large volume 'mammotome' biopsy in the management of screen-detected radial scars

Conventionally, radial scars (RSs) are surgically excised due to the risk of associated malignancy. However, in the absence of atypia on needle core biopsy (NCB), this risk is low. Mammotome biopsy allows further sampling such that a benign diagnosis may be accepted more confidently. We aimed to review its role as an alternative to surgery in the screening population.

Cases of screen-detected RS on NCB diagnosed between July 2004 and September 2008 were identified from pathology computer records. From January 2006, the mammotome device was used to further sample RS with no atypia on NCB. Prior to this, such patients underwent diagnostic surgery. Radiology and subsequent histology from both groups were analysed.

Twenty-five RSs were included in the study. Three had atypia on NCB and proceeded straight to surgery. Of the remaining 22 patients without atypia, 14 were planned for mammotome and 8 for surgical biopsy. Of the 14 mammotome patients, 11 proved benign. One case demonstrated atypia (lobular in situ neoplasia) on mammo-tome biopsy, prompting surgery at this point. Two patients proceeded to surgery due to failure of the mammotome to localise and adequately sample the lesion. Of the eight surgical biopsy patients, six were benign, one proved malignant (ductal carcinoma in situ) and one patient declined the operation.

Introduction of the mammotome device successfully avoided surgery in 78% (11 of 14) of eligible patients. Selective use of the mammotome in RS without atypia may significantly reduce the need for diagnostic surgery in the screening population.