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Purpose of the Review <p>Radial scars (RS) and flat epithelial atypia (FEA) are benign breast lesions found on core needle biopsies (CNB). Most are still being excised, but there is a recent trend towards observation. In this review, we seek to provide updated treatment recommendations.</p> Recent Findings <p>Upgrade rates to malignancy for RS without atypia on CNB are 0–9%; however, upgrade rates to atypia are high (16.1–34%). For RS with atypia on CNB, upgrade rates to malignancy are 17–33%. Pure FEA has upgrade rates to malignancy of 0-5%. However, FEA is often found in association with atypia. </p> Summary <p>Adequately sampled RS without atypia may undergo observation. RS with atypia should be excised. Adequately sampled pure FEA with radiologic-pathologic concordance may be observed. However, surgical consultation should continue to be offered for all RS and FEA. Vacuum-assisted biopsies with larger gauge needles lower the risk of underestimation; vacuum-assisted excisions may be a treatment option for RS and FEA.</p>

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An Update on Radial Scars and Flat Epithelial Atypia Lesions of the Breast

  • 期刊论文

  • 发表日期：

    2025年4月22日

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  • Frances Phang,
  • Chelsea Marin,
  • Anna Weiss

摘要

Purpose of the Review

Radial scars (RS) and flat epithelial atypia (FEA) are benign breast lesions found on core needle biopsies (CNB). Most are still being excised, but there is a recent trend towards observation. In this review, we seek to provide updated treatment recommendations.

Recent Findings

Upgrade rates to malignancy for RS without atypia on CNB are 0–9%; however, upgrade rates to atypia are high (16.1–34%). For RS with atypia on CNB, upgrade rates to malignancy are 17–33%. Pure FEA has upgrade rates to malignancy of 0-5%. However, FEA is often found in association with atypia.

Summary

Adequately sampled RS without atypia may undergo observation. RS with atypia should be excised. Adequately sampled pure FEA with radiologic-pathologic concordance may be observed. However, surgical consultation should continue to be offered for all RS and FEA. Vacuum-assisted biopsies with larger gauge needles lower the risk of underestimation; vacuum-assisted excisions may be a treatment option for RS and FEA.