Underestimation Rate in the Percutaneous Diagnosis of Radial Scar/Complex Sclerosing Lesion of the Breast: Systematic Review

Abstract Objective To evaluate the underestimation rate in breast surgical biopsy after the diagnosis of radial scar/complex sclerosing lesion through percutaneous biopsy. Data Sources A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The PubMed, SciELO, Cochrane, and Embase databases were consulted, with searches conducted through November 2020, using specific keywords (radial scar OR complex sclerosing lesion, breast cancer, anatomopathological percutaneous biopsy AND/OR surgical biopsy). Data collection Study selection was conducted by two researchers experienced in preparing systematic reviews. The eight selected articles were fully read, and a comparative analysis was performed. Study selection A total of 584 studies was extracted, 8 of which were selected. One of them included women who had undergone a percutaneous biopsy with a histological diagnosis of radial scar/complex sclerosing lesion and subsequently underwent surgical excision; the results were used to assess the underestimation rate of atypical and malignant lesions. Data synthesis The overall underestimation rate in the 8 studies ranged from 1.3 to 40% and the invasive lesion underestimation rate varied from 0 to 10.5%. Conclusion The histopathological diagnosis of a radial scar/complex sclerosing lesion on the breast is not definitive, and it may underestimate atypical andmalignant lesions, which require a different treatment, making surgical excision an important step in diagnostic evaluation.

摘要 目的：评估经皮穿刺活检（percutaneous biopsy）诊断为放射状瘢痕（radial scar）/复杂性硬化性病变（complex sclerosing lesion）后，乳腺外科活检中的低估率。数据来源：本研究遵循《系统评价与Meta分析优先报告条目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）指南开展系统评价。检索PubMed、SciELO、考克兰（Cochrane）及Embase数据库，检索时限截至2020年11月，采用特定检索词：（放射状瘢痕 OR 复杂性硬化性病变）、乳腺癌、经皮穿刺组织病理学活检（anatomopathological percutaneous biopsy）AND/OR 外科活检（surgical biopsy）。数据收集与研究筛选：由两名具备系统评价编制经验的研究者开展研究筛选工作，对最终筛选出的8篇文献进行全文阅读并开展对比分析。研究筛选概况：本次检索共提取584项研究，最终纳入8项。纳入的8项研究均针对经皮穿刺活检后组织病理学确诊为放射状瘢痕/复杂性硬化性病变、随后接受手术切除并送检病理的女性患者，其研究结果用于评估非典型病变（atypical lesion）与恶性病变（malignant lesion）的低估率。数据综合分析：8项研究的总体低估率范围为1.3%~40%，其中浸润性病变（invasive lesion）的低估率范围为0~10.5%。结论：乳腺组织病理学诊断为放射状瘢痕/复杂性硬化性病变并非确定性诊断，其可能低估需采取不同治疗方案的非典型与恶性病变，因此手术切除是诊断评估中的重要环节。