Radial scars of the breast: review of 38 consecutive mammographic diagnoses.

Abstract

The authors report 38 consecutive cases of histologically proved breast radial scars (RSs) detected at mammography. In a retrospective review of mammograms in 30 matched cases of nonpalpable RS and nonpalpable scirrhous cancer, the characteristic mammographic features of RS were confirmed: (a) the absence of a central opacity, often substituted by a radiolucent area; (b) the presence of multiple elongated thin spicules radiating from the center of the lesion; (c) the infrequency of any palpable finding, even for superficial lesions of relatively large size. Microcalcifications with aspecific structure were found in the lesions on mammograms of 14 of the 38 cases and in 24 of the histologic specimens. The typical mammographic features of RS were not specific to RS, being present in a minority of cancer cases. For two blinded readers, sensitivity was 86.7% and 76.7% and specificity was 78% and 80%, respectively. Although some specific mammographic features may suggest the presence of RS, the final differential diagnosis from scirrhous cancer should be based on histologic evidence, and surgical biopsy should be advised for any stellate lesion detected at mammography.

A review of needle core biopsy diagnosed radial scars in the Welsh Breast Screening Programme

“…Because of the difficulties assessing these lesions on radiological imaging, the final diagnosis of a radial scar should still be made on histology. 9 The incidence of premalignant or malignant histology in radial scars in this study is comparable with rates reported in the literature. Fasih et al 10 have reported rates from the Newcastle breast screening programme of 67% for pure radial scars, 17% for ADH and 16% for in situ or invasive carcinoma, compared with 68%, 18% and 14% (including LCIS), respectively, in this study.…”

Fourteen‐gauge needle core biopsy of mammographically evident radial scars

“…Radial scar also has variable associations with the marker lesions for increased breast carcinoma risk, ADH and LCIS. 14,15,18,20,29,30 Most studies have reported an association with ADH, which was seen in 57% of the women in the current study. The incidence of both ADH and LCIS among studies varies, presumably due to population differences, such as symptomatic versus asymptomatic status, patient age, and other risk factors like family or personal history of breast carcinoma.…”

“…1,8,12,23 It is widely believed that carcinoma frequently is associated with radial scars and, hence, that patients should be referred for diagnostic excision biopsy rather than needle core biopsy. 12,[15][16][17][18][19] The literature presents a confused picture with regard to the association of carcinoma with radial scar, with the incidence of associated breast carcinoma varying from 0% to 43%. 19,20,22,24,25,29,[31][32][33][34][35] The reported differences in the association of breast carcinoma with radial scars are difficult to reconcile.…”

“…30 Some studies reviewing radial scars have reported a high rate of association with DCIS and invasive carcinoma (up to 43% in one series). 18,19,29,30,33,34 These series derived patients from selected sources, such as a surgical service of a cancer hospital and other tertiary referral centers, where patients are more likely to be at risk of breast carcinoma. They were mostly case series, and not population-based studies.…”

“…[15][16][17][18][19][20] The characteristic features of radial scar include the presence of multiple long, thin radiating spiculations with parallel radiolucent lines, a central lucency or a heterogeneous center containing lucencies and varying appearance in different projections 15,16,18,20 -22 (Fig. 1).…”