Risk of malignancy after diagnosis of radial sclerosing lesion with associated atypia
9 affiliations
- 1Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1434, Houston, TX 77030 USA
- 2Universidad Central del Caribe, Bayamón, PR USA
- 3Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- 4Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- 5Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- 6Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- 7Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- 8Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- 9Institute for Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
Abstract
Purpose: When a radial sclerosing lesion (RSL) with associated epithelial atypia is diagnosed on image-guided core needle biopsy, current guidelines recommend complete excision to exclude malignancy. Prior studies have reported that a substantial proportion of such lesions will be ‘upgraded’ to malignancy when surgical excision is undertaken. More personalized management may be possible if subgroups with lower risk of harboring malignancy are identified.
Methods: Following a systematic review of existing studies, we conducted an observational cohort study including all RSLs with associated atypia diagnosed on image-guided needle biopsy performed at our institution from 2020 to 2025. We estimated the cumulative incidence of malignancy at the RSL site in subgroups defined by the type of epithelial atypia and whether the atypia involved the RSL or was in the adjacent tissue.
Results: A total of 105 RSLs with associated atypia were included. Surgical excision was performed following biopsy diagnosis for 22 of 24 (91.7%) with atypical ductal hyperplasia (ADH) involving the RSL, 17 of 35 (48.6%) with ADH in the adjacent tissue, 16 of 20 (80.0%) with lobular neoplasia or other atypia involving the RSL, and 7 of 26 (26.9%) with lobular neoplasia or other atypia in the adjacent tissue. The remaining lesions underwent imaging surveillance. The cumulative incidence of malignancy at 3 years was 29.2% (95% CI: 15.1, 51.6%) for lesions with ADH involving the RSL; 8.6% (95% CI: 2.8, 24.3%) for lesions with ADH in the adjacent tissue; and 2.2% (95% CI: 0.3, 14.4%) for lesions with lobular neoplasia or other atypia.
Conclusions: Lesions with ADH involving a RSL are likely to harbor malignancy. For other subgroups, the risk of malignancy is lower. These findings provide evidence that may be used to inform shared decision-making around imaging surveillance for selected patients with RSL and atypia on core needle biopsy.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10549-026-08103-3.
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BibTeX
@article{casanova2026risk,
title = {{Risk of malignancy after diagnosis of radial sclerosing lesion with associated atypia}},
author = {Lorena Beatriz Delgado Casanova and Sagar Dhamne and Erika Resetkova and Mary S. Guirguis and Yimin Geng and Therese Bartholomew Bevers and Isabelle Bedrosian and Lei Huo and Kerollos Nashat Wanis},
journal = {Breast Cancer Research and Treatment},
year = {2026},
month = oct,
doi = {10.1007/s10549-026-08103-3},
url = {https://doi.org/10.1007/s10549-026-08103-3},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Risk of malignancy after diagnosis of radial sclerosing lesion with associated atypia
AU - Lorena Beatriz Delgado Casanova
AU - Sagar Dhamne
AU - Erika Resetkova
AU - Mary S. Guirguis
AU - Yimin Geng
AU - Therese Bartholomew Bevers
AU - Isabelle Bedrosian
AU - Lei Huo
AU - Kerollos Nashat Wanis
PY - 2026
DA - 2026/10/26
JO - Breast Cancer Research and Treatment
DO - 10.1007/s10549-026-08103-3
UR - https://doi.org/10.1007/s10549-026-08103-3
AB - Purpose: When a radial sclerosing lesion (RSL) with associated epithelial atypia is diagnosed on image-guided core needle biopsy, current guidelines recommend complete excision to exclude malignancy. Prior studies have reported that a substantial proportion of such lesions will be ‘upgraded’ to malignancy when surgical excision is undertaken. More personalized management may be possible if subgroups with lower risk of harboring malignancy are identified. Methods: Following a systematic review of existing studies, we conducted an observational cohort study including all RSLs with associated atypia diagnosed on image-guided needle biopsy performed at our institution from 2020 to 2025. We estimated the cumulative incidence of malignancy at the RSL site in subgroups defined by the type of epithelial atypia and whether the atypia involved the RSL or was in the adjacent tissue. Results: A total of 105 RSLs with associated atypia were included. Surgical excision was performed following biopsy diagnosis for 22 of 24 (91.7%) with atypical ductal hyperplasia (ADH) involving the RSL, 17 of 35 (48.6%) with ADH in the adjacent tissue, 16 of 20 (80.0%) with lobular neoplasia or other atypia involving the RSL, and 7 of 26 (26.9%) with lobular neoplasia or other atypia in the adjacent tissue. The remaining lesions underwent imaging surveillance. The cumulative incidence of malignancy at 3 years was 29.2% (95% CI: 15.1, 51.6%) for lesions with ADH involving the RSL; 8.6% (95% CI: 2.8, 24.3%) for lesions with ADH in the adjacent tissue; and 2.2% (95% CI: 0.3, 14.4%) for lesions with lobular neoplasia or other atypia. Conclusions: Lesions with ADH involving a RSL are likely to harbor malignancy. For other subgroups, the risk of malignancy is lower. These findings provide evidence that may be used to inform shared decision-making around imaging surveillance for selected patients with RSL and atypia on core needle biopsy. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10549-026-08103-3.
SN - 0167-6806
SN - 1573-7217
ER -