The radial scar (RS) or complex sclerosing lesion (CSL) of the breast represents a management dilemma on diagnosis at breast core needle biopsy because of the risk of associated malignancy identified only upon surgical excision. To determine our experience, we retrospectively reviewed core needle biopsies performed at the Darlene G. Cass Breast Imaging Center from 2006 to 2011, identifying 67 patients with RS or CSL, and correlated histology at excisional biopsy with core biopsy results. Of the 67 cases, 6 (9%) were associated with malignancy at surgical excision. The average size of the RS or CSL was 1.42 cm. In conclusion, RS or CSL diagnosed at core needle biopsy still warrants surgical excision because of the significant percentage (9%) of cases with associated malignancy.