SPICULATED LESIONS OF THE BREAST - MAMMOGRAPHIC-PATHOLOGICAL CORRELATION

Spiculated breast lesions may be caused by both benign and malignant p rocesses, including sclerosing adenosis, postsurgical scar, radial sca r, tuberculosis (rare), posttraumatic oil cysts, infiltrating ductal c arcinoma, ductal carcinoma in situ (rare), infiltrating lobular carcin oma, and tubular carcinoma. Mammographically, such lesions are often s imilar, and only some can be differentiated on the basis of morphologi c characteristics. Although microcalcifications are often associated w ith breast carcinoma, not all spiculated lesions with microcalcificati ons are malignant. Sclerosing adenosis occurs with punctate microcalci fications, but the lesion often has a radiolucent center, compared wit h the opaque center generally found in malignant spiculated lesions. R adial 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 his tiocytes, or sclerotic stroma, whereas the spicules of malignant lesio ns 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 mammograp hic views, and needle or surgical biopsy are often required.