Radial Sclerosing Lesions of the Breast: High Histologic Concordance Found Between Core Needle Biopsy and Subsequent Surgical Excision Challenges Current Management Guidelines
Bibliographic record
Abstract
Radial sclerosing lesions of the breast, which include radial scars and complex sclerosing lesions, are common benign lesions that mimic invasive carcinoma on mammography and histology. The current approach requires a core needle biopsy for spiculated lesions on imaging, with the majority of lesions diagnosed as radial scars still undergoing subsequent surgical excision to ensure complete resection of potential concomitant and/or associated carcinomas or epithelial atypias. We reviewed our experience to determine radio-pathologic correlations. We searched the pathology archives of the Montreal Jewish General Hospital from 2000 to 2011 to identify all patients diagnosed with spiculated lesions (architectural distortions) on breast imaging, radial scar (without associated atypia or malignancy) on core needle biopsy, and who had subsequent surgical excision. There were 23 cases (selected from 11,156 core biopsies) that fulfilled these criteria. We tabulated primary diagnosis and other findings on core needle biopsy and on surgical excision. Only 1 of 23 cases showed associated atypical lobular hyperplasia on final excision. All 23 patients were women their ages ranged from 24 to 78 years with an average of 54.4 years. This high concordance rate between diagnosis on stereotactic or ultrasound-guided core needle biopsy and on subsequent surgical excision challenges the current widespread approach resulting in the majority of patients undergoing surgical excision in cases diagnosed as radial scars without atypia on core biopsy sampling. Further studies documenting a good radiology-pathology correlation with clinical-radiologic follow-up are needed to support management of radial sclerosing lesions by extensive sampling and/or excision with percutaneous vacuum-assisted stereotactic needle core biopsy and close clinicoradiologic follow-up.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".