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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(01): 067-073
DOI: 10.1055/s-0041-1741409
Review Article

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

Taxa de subestimação no diagnóstico percutâneo de cicatriz radiada/lesão esclerosante complexa da mama: Revisão sistemática
Ana Beatrice Bonganha Zanon 
1   Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
,
Jonathan Yugo Maesaka 
2   Divisão de Ginecologia, Setor de Mastologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
,
Bruna Bello Chequin 
2   Divisão de Ginecologia, Setor de Mastologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
,
Ana Gabriela de Siqueira Santos 
2   Divisão de Ginecologia, Setor de Mastologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
,
Edmund Chada Baracat 
1   Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
2   Divisão de Ginecologia, Setor de Mastologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
,
José Roberto Filassi 
1   Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
2   Divisão de Ginecologia, Setor de Mastologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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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 and malignant lesions, which require a different treatment, making surgical excision an important step in diagnostic evaluation.

Resumo

Objetivo Avaliar o grau de discordância entre biópsia percutânea e cirúrgica da mama em pacientes com diagnóstico de cicatriz radiada/lesão esclerosante complexa (CR/LEC) por meio de uma revisão sistemática.

Fontes dos dados Foi realizada uma revisão sistemática segundo as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, na sigla em inglês). As bases de dados primárias consultadas foram PubMed, SciELO, Cochrane e Embase, com buscas conduzidas até novembro de 2020, utilizando palavras chaves específicas (cicatriz radiada OU lesão esclerosante complexa, câncer de mama, anatomopatológico de biópsia percutânea E/OU biópsia cirúrgica).

Seleção dos estudos A busca dos artigos resultou em um total de 584 estudos, sendo 8 selecionados, os quais incluíam mulheres submetidas a biópsia com diagnóstico histológico de CR/LEC e posteriormente submetidas a exérese cirúrgica para avaliar como desfecho o grau de subestimação de lesões atípicas e malignas.

Coleta de dados A seleção dos estudos foi conduzida por dois pesquisadores, com experiência na elaboração de revisão sistemática. Os oito artigos selecionados foram lidos na íntegra e submetidos a uma análise comparativa.

Síntese dos dados Cicatrizes radiadas/lesões esclerosante complexas foram associadas com lesões atípicas e malignas após a exérese cirúrgica. O grau de subestimação geral foi calculado pela porcentagem de lesões atípicas e malignas no anatomopatológico após a exérese cirúrgica dentre o total de CR/LEC diagnosticadas, enquanto o grau de subestimação de lesões invasoras foi calculado considerando-se apenas os carcinomas invasivos. O grau de subestimação geral dos estudos selecionados variou de 1,3 a 40%, e o de lesões invasoras de 0 a 10,5%.

Conclusão O diagnóstico histopatológico de CR/LEC na mama não é definitivo, podendo subestimar lesões atípicas e malignas, cujo tratamento é distinto, tornando a exérese cirúrgica etapa fundamental na investigação diagnóstica.

Keywords

breast diseases - breast neoplasms/diagnosis - image-guided biopsy

Palavras-chave

doenças mamárias - neoplasias da mama/diagnóstico - biópsia guiada por imagem


Publication History

Received: 06 September 2020

Accepted: 13 October 2021

Article published online:
29 January 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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