Microscopic view of a radial scar in breast tissue.

Radial Scars After Breast Biopsy: When to Worry?

Avery Sinclair in Health & Wellness August 2025 • 4 min read.

"Navigating the Controversy: Understanding Histology, Imaging, and Management of Radial Scars Found During Breast Core Biopsy."

Radial scars are a common, benign finding in breast tissue. Diagnosed with increasing frequency thanks to advancements in imaging technology, particularly digital tomosynthesis, these lesions often present a management dilemma.

Historically, radial scars were identified incidentally during surgery for clinically suspicious masses or breast cancer. Now, they are frequently detected through routine mammography, ultrasound, or MRI, becoming targets for image-guided biopsies.

The challenge arises after a core biopsy reveals a radial scar. Uncertainty surrounds the scar's potential to become malignant and its possible coexistence with other high-risk lesions or even breast cancer. While a single, definitive guideline is impossible, this article offers a balanced perspective and outlines reasonable management strategies.

Understanding the Pathology of Radial Scars

Microscopic view of a radial scar in breast tissue.

Radial scars are characterized by a central fibroelastotic core with radiating spokes of ducts and lobules. Imagine a tiny bicycle wheel where the hub is a dense, fibrous center, and the spokes are normal breast structures stretched outwards.

These ducts and lobules often exhibit proliferative changes, such as hyperplasia, sclerosing adenosis, and cysts. Crucially, a healthy layer of myoepithelial cells surrounds these structures, a key feature in distinguishing radial scars from cancerous growths.

Size Matters (Sort Of): Some experts differentiate radial scars (less than 1 cm) from complex sclerosing lesions (larger than 1 cm), but both share similar characteristics.
Entrapment Illusion: Glandular elements can sometimes get trapped in the central core, mimicking tubular carcinoma under a microscope. Special staining techniques can help pathologists differentiate between benign and malignant cells.
Common, but Not Predictive: Autopsy studies reveal radial scars in 14% to 28% of unselected female breasts. Having a radial scar doesn't necessarily increase breast cancer risk beyond that associated with any accompanying proliferative changes.

While not inherently pre-cancerous, their presence warrants careful attention. Because radial scars can sometimes co-exist with cancerous or precancerous lesions, accurate diagnosis and appropriate management are essential.

Making Informed Decisions: The Path Forward

Managing radial scars after core biopsy requires a balanced approach. Current research suggests these lesions aren't inherently premalignant, but a small percentage are upgraded to malignancy after surgical removal, likely due to sampling errors during the core biopsy.

To minimize this risk, consider these general guidelines:

<ul> <li>Small Scars (≤ 1.0 cm): If the scar is small, well-sampled, and shows agreement between imaging and pathology, careful monitoring may suffice.</li> <li>Larger Scars (> 1.0 cm): Excision or repeat sampling with a larger-gauge vacuum-assisted device might be necessary to minimize sampling errors.</li> <li>Incidental Scars: Small, incidental scars found during biopsy of another lesion may only require imaging and clinical follow-up if the primary target is adequately sampled and concordant.</li> </ul> These recommendations are general and can be adapted based on individual factors such as personal history, sampling technique, and the relationship between the biopsy clip and lesion. When in doubt, surgical excision is the safest approach.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.2214/ajr.17.18156, Alternate LINK

Title: Radial Scars Of The Breast Encountered At Core Biopsy: Review Of Histologic, Imaging, And Management Considerations

Subject: Radiology, Nuclear Medicine and imaging

Journal: American Journal of Roentgenology

Publisher: American Roentgen Ray Society

Authors: Michael A. Cohen, Mary S. Newell

Published: 2017-11-01

Everything You Need To Know

What exactly defines a radial scar in breast tissue, and what key microscopic features differentiate it from potential malignancies?

Radial scars are characterized by a central fibroelastotic core with radiating spokes of ducts and lobules. These ducts and lobules often show proliferative changes like hyperplasia, sclerosing adenosis, and cysts. A critical feature is the presence of a healthy layer of myoepithelial cells surrounding these structures, which helps distinguish radial scars from cancerous growths. The architecture resembles a tiny bicycle wheel.

What are the main concerns when a radial scar is detected during a breast core biopsy, and why is careful follow-up necessary?

After a core biopsy reveals a radial scar, the primary concern is the potential for malignancy and the possibility of co-existing high-risk lesions or breast cancer. Although radial scars are not inherently pre-cancerous, a small percentage may be upgraded to malignancy after surgical removal. This is often attributed to sampling errors during the core biopsy, emphasizing the need for careful evaluation and management.

How can pathologists distinguish radial scars from tubular carcinoma, given that they can sometimes look similar under a microscope?

Distinguishing between radial scars and cancerous growths, such as tubular carcinoma, can be challenging because glandular elements can sometimes be trapped in the central core of a radial scar, mimicking cancerous cells under a microscope. Special staining techniques can assist pathologists in accurately differentiating between benign and malignant cells, ensuring a correct diagnosis and appropriate management strategy.

If radial scars are commonly found in breast tissue, does having one automatically increase my risk of developing breast cancer?

While autopsy studies indicate that radial scars are found in a significant percentage of unselected female breasts, their presence alone does not automatically elevate breast cancer risk beyond that associated with any accompanying proliferative changes. It is important to consider the characteristics of the radial scar along with any other breast changes when assessing overall risk.

What aspects of radial scar diagnosis and management are not fully covered, and why is further research needed in those areas?

Although the provided information focuses on the characteristics, diagnosis, and management of radial scars, it does not delve into the specific imaging techniques used for their detection, such as digital tomosynthesis, ultrasound, or MRI. Additionally, the psychological impact on patients receiving a radial scar diagnosis and the long-term surveillance strategies are not discussed in detail. Further research into these areas would provide a more comprehensive understanding of the implications of radial scars.