Radial scars without atypia in percutaneous biopsy specimens: can they obviate surgical biopsy? / Cicatriz radial sin atipia en biopsia percutánea. ¿Puede evitarse la biopsia quirúrgica?

OBJECTIVE: To evaluate the need for surgical biopsy in patients diagnosed with radial scars without atypia by percutaneous biopsy. MATERIAL AND METHODS: In this retrospective observational study, we selected patients with a histological diagnosis of radial scar in specimens obtained by percutaneous biopsy during an 8-year period. The statistical analysis was centered on patients with radial scar without atypia (we assessed the radiologic presentation, the results of the percutaneous biopsy, and their correlation with the results of surgical biopsy and follow-up) and we added the patients with atypia and cancer in the elaboration of the diagnostic indices. RESULTS: We identified 96 patients with radial scar on percutaneous biopsy; 54 had no atypia, 18 had atypia, and 24 had cancer. Among patients with radial scar without atypia, there were no statistically significant differences between patients who underwent imaging follow-up and those who underwent surgical biopsy (p>0.05). The rate of underdiagnosis for percutaneous biopsy in patients without atypia was 1.9%. The rates of diagnosis obtained with percutaneous biopsy in relation to follow-up and surgical biopsy in the 96 cases were sensitivity 92.3%, specificity 100%, positive predictive value 100%, negative predictive value 97.2%, and accuracy 97.9%. The area under the ROC curve was 0.96 (p<0.001), and the kappa concordance index was 0.95 (p<0.001) CONCLUSIONS: We consider that it is not necessary to perform surgical biopsies in patients with radial scars without atypia on percutaneous biopsies because the rate of underestimation is very low and the concordance between the diagnosis reached by percutaneous biopsy and the definitive diagnosis is very high.

Hiperplasia estromal seudoangiomatosa nodular de mama en dos adolescentes / Nodular pseudoangiomatous stromal hyperplasia of the breast in two adolescents

La hiperplasia estromal seudoangiomatosa nodular es una lesión benigna de la mama muy rara (el 0,4% de las biopsias). Se presenta como un nódulo palpable de rápido crecimiento en mujeres de entre 30 y 40 años, y es excepcional en adolescentes. Histológicamente consiste en la proliferación de las células estromales del tejido conectivo formando espacios seudovasculares vacíos anastomosados y tapizados por miofibroblastos. Presentamos el caso de 2 adolescentes (13 y 18 años) con un nódulo palpable en la mama de crecimiento rápido. En ambas se realizaron una ecografía mamaria y una biopsia con aguja gruesa. Los hallazgos ecográficos en la hiperplasia estromal seudoangiomatosa nodular fueron indistinguibles de los hallazgos descritos en el fibroadenoma juvenil y en el tumor filoides. Por lo tanto, fue necesario el estudio histológico de la lesión para obtener un diagnóstico definitivo. El tratamiento depende del tamaño del nódulo. En nuestras 2 pacientes, la lesión se extirpó quirúrgicamente mediante tumorectomía y mastectomía(AU)

Nodular pseudoangiomatous stromal hyperplasia is a very rare benign breast lesion found in 0.4% of biopsies. It usually presents as a fast-growing palpable lesion in women between 30 and 40 years of age and is exceptionally rare in adolescents. Histological examination reveals a proliferation of stromal cells from connective tissue forming anastomosed empty pseudovascular spaces lined with myofibroblasts. We present the cases of two adolescents (13 and 18 years old) with fast-growing palpable breast nodules. Both underwent breast ultrasonography and core biopsy. The ultrasonographic findings of nodular pseudoangiomatous stromal hyperplasia were indistinguishable from those reported for juvenile fibroadenoma and for phyllodes tumor. Thus, histological study was required for the definitive diagnosis. Treatment depends on the size of the nodule. In our two patients, the lesion was surgically excised through tumorectomy and mastectomy(AU)

[Nodular pseudoangiomatous stromal hyperplasia of the breast in two adolescents]. / Hiperplasia estromal seudoangiomatosa nodular de mama en dos adolescentes.

Nodular pseudoangiomatous stromal hyperplasia is a very rare benign breast lesion found in 0.4% of biopsies. It usually presents as a fast-growing palpable lesion in women between 30 and 40 years of age and is exceptionally rare in adolescents. Histological examination reveals a proliferation of stromal cells from connective tissue forming anastomosed empty pseudovascular spaces lined with myofibroblasts. We present the cases of two adolescents (13 and 18 years old) with fast-growing palpable breast nodules. Both underwent breast ultrasonography and core biopsy. The ultrasonographic findings of nodular pseudoangiomatous stromal hyperplasia were indistinguishable from those reported for juvenile fibroadenoma and for phyllodes tumor. Thus, histological study was required for the definitive diagnosis. Treatment depends on the size of the nodule. In our two patients, the lesion was surgically excised through tumorectomy and mastectomy.

Organización de una Unidad de Radiología de Mama / The organization of a breast imaging department

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