放射状瘢痕和复杂硬化病变，通常被统称为放射状硬化病变（RSLs），是以硬化的结缔组织为特征，包裹着上皮元素的乳腺病变。由于其可疑的成像特征与乳腺恶性肿瘤相似，RSLs常常成为成像引导下活检的目标。这些病变可以单独存在，也可以与非典型增生或其他潜在恶性病变一同存在，增加了癌症的风险，并影响了RSLs的预后和管理。因此，这些病变的管理仍然存在争议。传统的处理方法是手术切割活检。然而，随着越来越多的RSLs被发现（因为数字乳腺断层成像可以辨别出更多的结构扭曲），最佳的管理方式正在不断发展。在决定对这些病变进行手术切割还是成像随访时，一些医生以多学科的方式来管理RSLs。这些讨论还纳入了个体患者的风险因素和更多的患者知情医学决策。报道的RSLs在核心针活检中的升级率各不相同，可能取决于采样方法、样本数量、针的规格、目标采样以及放射学和病理学的一致性或不一致性。精确的采样技术也可以提高诊断准确性，降低这些病变的升级率，放射学和病理学的关联性是进一步管理决策的一个重要组成部分。作者回顾了RSLs的总体组织病理学、临床和成像特征，并根据目前可用的升级率数据讨论了适当的治疗管理。©RSNA，2023 本文的问答题可以通过在线学习中心获取。

Radial scars and complex sclerosing lesions, often collectively referred to as radial sclerosing lesions (RSLs), are breast lesions characterized by sclerotic stroma with entrapped epithelial elements. RSLs have imaging features that overlap with those of breast malignancy and often become the target of imaging-guided biopsy given their suspicious imaging appearance. These can be identified in isolation or can also be associated with atypia or other high-risk lesions that have intrinsic malignant potential, increasing the risk of carcinoma and affecting prognosis and management of RSLs. Because of this, management of these lesions remains controversial. Traditional management has been surgical excisional biopsy. However, as more RSLs are identified (because digital breast tomosynthesis allows identification of more architectural distortions), optimal management is evolving. Physicians in some practices are using a multidisciplinary approach to the management of RSLs when deciding on surgical excision of these lesions versus imaging follow-up. These discussions also incorporate individual patient risk factors and greater patient informed medical decision making. Reported upgrade rates of RSLs at core needle biopsy vary and can depend on the sampling method, number of samples, gauge of the needle, target being sampled, and radiologic-pathologic concordance or discordance. A precise sampling technique also allows greater accuracy of diagnosis and lower upgrade rates for these lesions, with radiologic-pathologic correlation as an integral component for further management decisions. The authors review the overall histopathologic, clinical, and imaging features of RSLs and discuss appropriate management based on currently available data regarding upgrade rates. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.