Spiculated lesions of the breast: mammographic-pathologic correlation

Spiculated breast lesions may be caused by both benign and malignant processes, including sclerosing adenosis, postsurgical scar, radial scar, tuberculosis (rare), posttraumatic oil cysts, infiltrating ductal carcinoma, ductal carcinoma in situ (rare), infiltrating lobular carcinoma, and tubular carcinoma. Mammographically, such lesions are often similar, and only some can be differentiated on the basis of morphologic characteristics. Although microcalcifications are often associated with breast carcinoma, not all spiculated lesions with microcalcifications are malignant. Sclerosing adenosis occurs with punctate microcalcifications, but the lesion often has a radiolucent center, compared with the opaque center generally found in malignant spiculated lesions. Radial scar may occasionally occur with microcalcifications and usually has a radiolucent center, but the latter is not a reliable criterion for differentiation from carcinoma. The spicules of benign lesions are often caused by fibrous tissue, lipid-filled spaces surrounded by histiocytes, or sclerotic stroma, whereas the spicules of malignant lesions are due to tumor infiltration, desmoplastic response, or periductal fibrosis. Mammography alone is frequently not reliable for making the specific diagnosis. Clinical breast examination, additional mammographic views, and needle or surgical biopsy are often required.