Excision of benign breast lump

[mebbob]

I am a 50 yr. old pre-menopausal female.  I had 2 breast lumps biopsied last year that were diagnosed as fibroadenomas.  On my follow-up check-up last month, 4 more lumps were identified, and 2 were biopsied, using ultrasound guided core needle biopsy.  One was a fibroadenoma, and the other was diagnosed as follows:
Benign sclerosing lesion
fibroadenoma
usual ductal hyperplasia, moderate
hyperplastic unfolded lobules
apocrine adenosis
negative for malignancy
Comment:The differential diagnosis of this benign sclerosing lesion includes radial scar, complex sclerosing lesion and complex fibroadenoma.  Management of radial scar is somewhat controversial.

I am having trouble finding information on some of these terms--can you enlighten me?  My Dr. wants to do an excisional biopsy of this lump--but I question the necessity of that if this is a benign condition.  I am concerned about scarring causing future mammograms to be harder to read.  Are these usually removed, and if so, why?  Thank you for any information you can give me.    

[PJBC]

A related discussion, radial scaring was started.

[surgeon]

All of the things described in the report are benign. The question sometimes arises as to when a finding could denote a possibility that there could be something else nearby: sometimes when there is a cancer it can have reactive changes around it, and if the biopsy only sampled the reactive changes, it would show no cancer but would have missed what's really. Of the abnormalities mentioned, the radial scar is presumably the one about which such a question could be raised. As was said in the answer above, and in the pathology report, radial scar is not fully understood. It's not a worrisome finding per se. The question, in a partial sample such as you had, is whether there could be a cancer nearby that caused it to appear. The answer is almost surely "no." But some people think the safest thing is to fully remove the area to be sure. As to future mammograms: it's a good idea after a biopsy to get a new baseline xray 3-6 months later. That way, you have the changes due to the biopsy on record, and a way to compare to possible future changes. Having a biopsy ought not to make future mammograms hard to interpret unless a long time passes between the biopsy and the next xray.

[mebbob]

Radial scar was just part of the differential diagnosis in the Comments section--not part of the original diagnosis.  What about the original diagnosis?  Is excision the normal course of action?

[mebbob]

Thank you, surgeon!  Your answer was extremely helpful.

[CCF-RN,MSN-rf]

Dear mebbob:  A radial scar is a benign finding. Doctors are not sure how radial scars develop in the breast. They cannot be seen with the naked eye, nor can they be felt in a breast exam. Their name comes from the way they look under the microscope. Compared to normal breast tissue, which shows random clusters of ducts surrounded by supporting connective tissue, radial scars have a core of apparently scarred tissue surrounded by ducts radiating out from the center.

There has been one study that suggests that the presence of radial scars may increase the risk of developing breast cancer. This is especially true in women with other risk factors. You May benefit from a second opinion, preferably with a breast specialist, to discuss interventions as well as your risk factors and any recommendations for future surveillance.