Prise en charge des cicatrices radiaires et lésions sclérosantes complexes du sein diagnostiquées par macrobiopsies assistées par le vide : l’exérèse chirurgicale est-elle toujours nécessaire ?

Abstract : Introduction: diagnosis of radial scars and complex sclerosing lesions (RS/CSL) by percutaneous biopsy carries a risk of histological underestimation. Consequently, surgical excision is often performed in order to exclude a possible associated malignancy. The aim of this study was to assess the rate of “upgrade to carcinoma” upon subsequent surgical excision of RS/CSLs diagnosed by vacuum-assisted large-core biopsy (VALCB). We also analyzed the risk factors for upgrade in order to determine a subset of patients who could avoid surgery and benefit from a conservative management with clinical and imaging follow-up. Material and methods: this is a retrospective observational single-center study on 174 consecutive RS/CSL diagnosed by VALCB from May 2008 to October 2015. Univariate analysis was performed to identify clinical, radiological and histological risk factors for upgrade. Results: surgical excision was performed following VALCB diagnosis of 88 RS/CSL with or without associated atypia. The overall rate of surgical upgrade to carcinoma was 9.1% (8/88). None of the benign biopsies without atypia were surgically upgraded. In addition to atypia, risk factors for upgrade were mammographic size, mammographic appearance and number of fragments obtained during the biopsy procedure (p < 0.05). Conclusion: we demonstrate that VALCB revealing RS/CSL is reliable to exclude malignancy when there is no associated atypia and when radiological and histological findings are concordant. In such cases, surgery can be avoided in favour of a clinical and imaging follow-up. When RS/CSL is associated with atypia, the decision to perform surgical excision depends on other associated risk factors.
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Master Thesis
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Submitted on : Thursday, March 14, 2019 - 6:54:03 PM
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Julia Bacci. Prise en charge des cicatrices radiaires et lésions sclérosantes complexes du sein diagnostiquées par macrobiopsies assistées par le vide : l’exérèse chirurgicale est-elle toujours nécessaire ?. Médecine humaine et pathologie. 2018. ⟨dumas-02068331⟩

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