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Low Radiologic Sensitivity in Detecting Radiation-Associated Breast Angiosarcoma (RAS).

Jonathan Fakhry¹, Mariam Hanna¹

¹Breast Imaging, University of Florida College of Medicine, Gainesville, USA.

|April 24, 2023

Summary

Radiation-associated breast angiosarcoma (RAS) is rare and difficult to detect with standard screening. Early MRI and biopsy are recommended for high-risk patients with concerning symptoms after radiation treatment.

Keywords:

breast cancer screening invasive ductal carcinoma lumpectomy radiation therapy secondary breast angiosarcoma

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Area of Science:

Oncology
Radiology
Pathology

Background:

Radiation-associated breast angiosarcoma (RAS) is a rare malignancy.
Current screening guidelines for RAS are ambiguous and lack sensitivity.
Mammography and ultrasonography often misinterpret RAS as benign changes.

Observation:

A case study of an 83-year-old woman with a history of breast cancer treated with lumpectomy and radiation.
The patient developed a suspicious lesion 5 years post-treatment, initially showing benign features on imaging.
Biopsy confirmed radiation-associated angiosarcoma within the irradiated breast tissue.

Findings:

Routine screening mammography and ultrasonography have low sensitivity for detecting RAS.
RAS can be mistaken for benign breast changes in approximately 50% of cases.
Delayed diagnosis of RAS can occur due to limitations in current screening modalities.

Implications:

High-risk patients (e.g., >0.5 Gy radiation, concerning symptoms 2-10 years post-treatment) require advanced screening.
Magnetic Resonance Imaging (MRI) with biopsy is recommended for initial evaluation of concerning lesions in high-risk patients.
Biopsy should be considered even with benign imaging findings in this patient cohort to rule out angiosarcoma.