Is pre-operative ultrasound assessment useful in the diagnosis of radial scars (RS)/complex sclerosing lesions (CSL)?

Many screen-detected radial scars (RS)/complex sclerosing lesions (CSL) are associated with malignant disease. The role of ultrasound in pre-operative evaluation is uncertain. Our aim was to determine whether ultrasound was able to detect associated pathology in such lesions. The ultrasound scans of 38 women (age range 37–65 years) with a definitive diagnosis of RS/CSL at excision biopsy were reviewed by one radiologist who was blinded to the identity of the patients and their previous ultrasound reports. Eight features were reviewed and, based on these, a probability of malignancy was recorded on a scale of 1 to 10. The radiologist's report and definitive histology were compared. Lesions were not visible on ultrasound in eight patients (21%). Three patients had invasive carcinoma; their scores were 8, 7 and 2 (mean 5.7). Of two patients with ductal carcinoma in situ, scores were both 6. Combining the scores for those with associated malignant pathology gave a mean score of 5.8. The mean score of patients with benign RS/CSL was 4.7. Three ultrasound features were found in all cases with associated malignant disease; posterior shadowing, an hypo-echoic margin and the absence of microlobulation. However, these were also present in the majority with benign RS/CSL. Ultrasound tended to underestimate the size of the lesion, independent of its nature.

Pre-operative ultrasound cannot reliably predict the presence of pathology associated with RS/CSL, but a larger series is required to confirm these findings.