Imaging in Dublin 2022 Radiology Conference
Recent Posts
Search

Radial Scars and Invasive Breast Cancer

Updated: Mar 12

New Left Breast Thickening in 67F • Xray of the Week 2017 • Week #4

This 67 year old asymptomatic woman was called back from mammography screening for assessment of the finding detected on the mammograms of her left breast. In addition, there was a slight palpable thickening in the lateral portion of the left breast at clinical breast examination.

What two processes are present?

Radial Scars and Invasive Breast Cancer - Earlier mammogram

Figure 1. a-d. Mediolateral (a,b) and craniocaudal (c,d) mammograms of the previous screening examination, 24 months before diagnosis and treatment. This examination was read as normal. The subtle contour change of the fibroglandular tissue seen retrospectively on the left CC projection was not appreciated at this examination.

Radial Scars and Invasive Breast Cancer - mammogram

Figure 2. a-d. MLO (a,b) and CC (c,d) projections. The patient was called back from screening for further assessment of the asymmetric density with slight architectural distortion seen in the lateral portion of the left breast. The <10 mm, low density, oval lesion in the medial portion of the right breast is a mole (nevus).

Radial Scars and Invasive Breast Cancer - mammogram

Figure 3 a,b. Microfocus magnification mammograms, MLO (a) and CC (b) projections. The architectural distortion is seen best on the craniocaudal projection (b): There is no central tumor mass and the radiating structure consists of drooping linear radiolucencies, characteristic for a radial scar (“black star”). No mammographic signs of malignancy are demonstrable.

Radial Scars and Invasive Breast Cancer - ABUS

Figure 4: ABUS multislice series, images 7-12/18. There is an obvious tissue defect in the upper half of the breast in images 7-10/18 (encircled), suggesting the presence of a pathologic lesion.

Radial Scars and Invasive Breast Cancer - ABUS

Figure 5 a,b. Placing the cursor over the tissue defect on ABUS image 9/18 produces a reconstructed 2D ultrasound image, showing a small malignant lesion. However, there is a discrepancy between the finding on ABUS and the finding on the mammogram.

Radial Scars and Invasive Breast Cancer - MRI

Figure 6 a-f. Breast MRI examination using a body-coil. MIP reconstructions showing bilateral moderate background enhancement. In the upper portion of the left breast there is a 5x4 cm area with many small enhancing areas and architectural distortion within the fibroglandular tissue. In the central portion there are a few lesions, having rapid washin and washout in the delayed phase. In addition, there is a small post biopsy hematoma adjacent to the above described lesions (Figs d-f) d (T2w) e (STIR) f (T1w pre contrast).

Hemangioma of the breast - Microfocus magnification radiograph of specimen

Figure 7. Microfocus magnification radiograph of specimen slice # 1. Numerous stellate lesions and architectural distortion can be found in this specimen radiograph. No malignant type calcifications are demonstrable.

Radial scars and Breast Cancer large format, subgross (3D) histopathology

Figure 8. The corresponding large format, subgross (3D) histopathology image of slice #1 shows the stellate lesions and the radiating structures. There are three invasive cancer foci (within white circles) and several radial scars (within black circles). Histology images are courtesy of Tibor Tot, MD PhD - Associate Professor, Department of Pathology and Clinical Cytology, Central Hospital Falun, Falun, Sweden

Laszlo Tabar Mammography Education 2017 Banner

Discussion

Final histopathology: Multifocal invasive breast cancer (8x7 mm, 6x4 mm, 2x2 mm, 2x1 mm) associated with cancer in situ over a region measuring 30x25 mm. pN 0/2. Biomarkers: ER/PR+ve, Ki67 15%, HER2-ve. Several radial scars can be seen in the segmentectomy specimen. Comment: Perception of architectural distortion on the mammograms is a difficult task. Once perceived, history helps us rule out traumatic fat necrosis, a common cause of architectural distortion. Clinical breast examination is mandatory when the finding on the mammogram is architectural distortion. Radial scar, the second most common benign lesion causing architectural distortion is seldom palpable, regardless of its size or location. However, radial scars can be associated with carcinoma in situ and/or small invasive carcinoma or even with multifocal invasive cancers. When the analysis of the mammograms suggests a radial scar, but there is a “thickening” upon clinical breast examination (such as in this case), then the lesion may be a radial scar associated with invasive carcinoma. The alternative diagnoses are either neoductgenesis (duct forming invasive carcinoma) or diffusely infiltrating cancer of apparent mesenchymal origin. The multimodality approach and thorough histopathologic examination using large format histopathology is needed to arrive at the correct diagnosis.

Learn more about early detection of breast cancer and radiologic/pathologic correlation from one of the world's leading experts, Dr. László Tabár and Israeli breast imager Dr. Tamar Sella at Imaging in Israel - 2017.

Other breast imaging cases:

Invasive Ductal Carcinoma of the Breast in 27 Year Old

Phyllodes Tumor

Medullary Breast Cancer

Hemangioma of Breast

References:

1. Orel SG, Evers K, Yeh IT et-al. Radial scar with microcalcifications: radiologic-pathologic correlation. Radiology. 1992;183 (2): 479-82.

2. Tabár L, Dean PB, Tot T. Teaching atlas of mammography. George Thieme Verlag. (2001) ISBN:0865779627. Find it at Amazon

3. Alleva DQ, Smetherman DH, Farr GH et-al. Radial scar of the breast: radiologic-pathologic correlation in 22 cases. Radiographics. 1999;19 Spec No : S27-35.

4. Carder PJ, Liston JC. Will the spectrum of lesions prompting a "B3" breast core biopsy increase the benign biopsy rate? J. Clin. Pathol. 2003;56 (2): 133-8.

5. Mokbel K, Price RK, Carpenter R. Radial scars and breast cancer. N. Engl. J. Med. 1999;341 (3): 210.

6. Wolfe JN. Breast patterns as an index of risk for developing breast cancer. AJR Am J Roentgenol. 1976;126 (6): 1130-7.

László Tabár, MD

László Tabár, MD, FACR (Hon) the Professor Emeritus of Radiology Uppsala University, Faculty of Medicine, Sweden and the Medical Director Emeritus of the Department of Mammography, Falun Central Hospital, Sweden. Through his company, Mammography Education, Inc, he has also been the course director and principal lecturer at more than 300 mammography courses on 6 continents. His pioneering research has laid the foundation for early detection through modern mammographic screening. Dr. Tabár is the recipient of numerous awards including the Gold Medal from the Society of Breast Imaging, American Cancer Society's Distinguished Service Award, and the first Alexander Margulis Award for Scientific Excellence from the Radiological Society of North America (RSNA). Dr. Tabár will be sharing his vast knowledge of breast imaging at Imaging in Israel - 2017.

All Posts by László Tabár, MD

All Breast Imaging Posts

Live Courses
Imaging in Dublin 2022 Banner Square.png
Search By Tags
Follow Us
  • Wix Facebook page
  • LinkedIn Social Icon
  • Twitter Social Icon
  • YouTube Social  Icon