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Surgical Pathology Criteria

Radial Scar of the Breast


  • A benign breast lesion with a stellate architecture that may simulate invasive carcinoma mammographically, clinically, grossly and microscopically

Alternate / historical names

  • Sclerosing papilloma
  • Sclerosing duct lesion

Diagnostic Criteria

    Richard L Kempson MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting: May 1, 2006


Supplemental studies


  • The tubules of radial scar contain a layer of myoepithelial cells
  • Demonstration of myoepithelial cells can confirm the in situ or benign nature of a process while their absence supports invasion
    • A variety of markers have been used for myoepithelial cells
    • We prefer to use both p63 and calponin on problematic cases

    Marker Sensitivity Specificity
    Calponin Excellent Very good
    p63 Excellent Excellent
    Smooth muscle myosin heavy chain Good Excellent
    CD10 (CALLA) Good Good
    High molecular weight cytokeratin Very good Poor
    Maspin Good Poor
    S100 Good Very poor
    Actin Good Very poor

Differential Diagnosis

Tubular Carcinoma Radial Scar
Single layer of cells Often multiple cell layers
No myoepithelial cells Myoepithelial cells present
Frequent infiltration of fat by naked tubules No bare infiltration of fat
No epithelial hyperplasia May show epithelial hyperplasia
Both have a stellate configuration with radiating fibrous arms and fibroelastotic stroma


Infiltrating Ductal Carcinoma Radial Scar
Cells may show various levels of atypia Cytologically bland cells
No myoepithelial cells Myoepithelial cells present
Frequent infiltration of fat by naked tubules No bare infiltration of fat
May show various infiltrative patterns Stellate configuration

Radial Scar, Sclerosing Adenosis, Ductal Adenoma and Nipple Adenoma

  • May be considered a spectrum of lesions differing in location and predominant pattern
  • All are benign


  • Radial scar (in the absence of associated DCIS) is considered a marker of increased risk of carcinoma rather than a precursor lesion
    • In an excisional biopsy, margins are not relevant if it is the only lesion

Relative risk for development of invasive breast carcinoma

  • No increased risk
    • Non-proliferative fibrocystic change
    • Fibroadenoma
    • Solitary papilloma
  • Slightly increased risk (1.5 to 2 times)
    • Proliferative fibrocystic change
    • Usual ductal hyperplasia
    • Sclerosing adenosis (florid)
    • Radial scar
    • Complex fibroadenoma (approximately 3 times risk)
  • Moderately increased risk (4 to 5 times)
    • Atypical ductal hyperplasia (no family history)
    • Atypical lobular hyperplasia
  • High risk (8 to 10 times)
    • Ductal carcinoma in situ, low grade
    • Lobular carcinoma in situ
    • Atypical ductal hyperplasia, if history of carcinoma in primary relatives
  • Very high risk (precise level not known)
    • Ductal carcinoma in situ, high grade


  • Andersen JA, Carter D, Linell F. A symposium on sclerosing duct lesions of the breast. Pathol Annu. 1986;21 Pt 2:145-79.
  • Andersen JA, Gram JB. Radial scar in the female breast. A long-term follow-up study of 32 cases. Cancer. 1984 Jun 1;53(11):2557-60.
  • Anderson TJ, Battersby S. Radial scars of benign and malignant breasts: comparative features and significance. J Pathol. 1985 Sep;147(1):23-32.
  • Sloane JP, Mayers MM. Carcinoma and atypical hyperplasia in radial scars and complex sclerosing lesions: importance of lesion size and patient age. Histopathology. 1993 Sep;23(3):225-31.
  • Jacobs TW, Byrne C, Colditz G, Connolly JL, Schnitt SJ. Radial scars in benign breast-biopsy specimens and the risk of breast cancer. N Engl J Med. 1999 Feb 11;340(6):430-6.

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