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Circumscribed and Obscured Margins
Nicole S. Winkler, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Circumscribed: Well-defined margins with abrupt interface between mass and surrounding tissue
                • ≥ 75% of margin sharply defined on mammography
                  • < 25% of margin may be obscured by overlying tissue
                • Entire margin must be well defined on US or MR to be classified as circumscribed by those modalities
              • Obscured: Predominantly circumscribed mass, but ≥ 25% of margin hidden by surrounding fibroglandular tissue
                • Term only used for mammography (not part of US or MR lexicon)
              • If any portion of margin spiculated, indistinct, or microlobulated, do not classify as circumscribed or obscured
                • Classify based on most suspicious component

            IMAGING

            • Mammographic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Chan HP et al: Characterization of breast masses in digital breast tomosynthesis and digital mammograms: an observer performance study. Acad Radiol. 24(11):1372-1379, 2017
                                  2. Nakashima K et al: Comparison of visibility of circumscribed masses on digital breast tomosynthesis (DBT) and 2D mammography: are circumscribed masses better visualized and assured of being benign on DBT? Eur Radiol. 27(2):570-577, 2017
                                  3. Sippo DA et al: Metastatic disease to the breast from extramammary malignancies: a multimodality pictorial review. Curr Probl Diagn Radiol. 45(3):225-32, 2016
                                  4. Kim SY et al: Combined use of ultrasound elastography and B-mode sonography for differentiation of benign and malignant circumscribed breast masses. J Ultrasound Med. 34(11):1951-9, 2015
                                  5. Berg WA et al: Multiple bilateral circumscribed masses at screening breast US: consider annual follow-up. Radiology. 268(3):673-83, 2013
                                  6. Mendelson EB et al: Breast Imaging Reporting and Data System, BI-RADS: Ultrasound. 2nd ed. Reston, VA: American College of Radiology, 2013
                                  7. Morris EA et al: Breast Imaging Reporting and Data System: BI-RADS, Magnetic Resonance Imaging. 2nd ed. Reston, VA: American College of Radiology, 2013
                                  8. Sickles EA et al: Breast Imaging Reporting and Data System, BI-RADS: Mammography. 5th ed. Reston, VA: American College of Radiology, 2013
                                  9. Boisserie-Lacroix M et al: Triple-negative breast cancers: associations between imaging and pathological findings for triple-negative tumors compared with hormone receptor-positive/human epidermal growth factor receptor-2-negative breast cancers. Oncologist. 18(7):802-11, 2013
                                  10. Berg WA et al: Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology. 262(2):435-49, 2012
                                  11. Boisserie-Lacroix M et al: Radiological features of triple-negative breast cancers (73 cases). Diagn Interv Imaging. 93(3):183-90, 2012
                                  12. Mahoney MC et al: Positive predictive value of BI-RADS MR imaging. Radiology. 2012;264:51-8, 2012
                                  13. Noroozian M et al: Digital breast tomosynthesis is comparable to mammographic spot views for mass characterization. Radiology. 262(1):61-8, 2012
                                  14. Glazebrook KN et al: Imaging features of carcinoid tumors metastatic to the breast. Cancer Imaging. 11:109-15, 2011
                                  15. Kojima Y et al: Mammography and ultrasound features of triple-negative breast cancer. Breast Cancer. 18(3):146-51, 2011
                                  16. Woods RW et al: The mammographic density of a mass is a significant predictor of breast cancer. Radiology. 258(2):417-25, 2011
                                  17. Ko ES et al: Triple-negative breast cancer: correlation between imaging and pathological findings. Eur Radiol. 20(5):1111-7, 2010
                                  18. Yoo JL et al: Can MR imaging contribute in characterizing well-circumscribed breast carcinomas? Radiographics. 30(6):1689-702, 2010
                                  19. Harvey JA et al: Short-term follow-up of palpable breast lesions with benign imaging features: evaluation of 375 lesions in 320 women. AJR Am J Roentgenol. 193(6):1723-30, 2009
                                  20. Kim SH et al: Correlation of ultrasound findings with histology, tumor grade, and biological markers in breast cancer. Acta Oncol. 47(8):1531-8, 2008
                                  21. Park YM et al: Palpable breast masses with probably benign morphology at sonography: can biopsy be deferred? Acta Radiol. 49(10):1104-11, 2008
                                  22. Noguera JJ et al: Metastases to the breast: a review of 33 cases. Australas Radiol. 51(2):133-8, 2007
                                  23. Hong AS et al: BI-RADS for sonography: positive and negative predictive values of sonographic features. AJR Am J Roentgenol. 184(4):1260-5, 2005
                                  24. Sickles EA et al: Performance benchmarks for diagnostic mammography. Radiology. 235(3):775-90, 2005
                                  25. Graf O et al: Follow-up of palpable circumscribed noncalcified solid breast masses at mammography and US: can biopsy be averted? Radiology. 233(3):850-6, 2004
                                  26. Lam WW et al: Sonographic appearance of mucinous carcinoma of the breast. AJR Am J Roentgenol. 182(4):1069-74, 2004
                                  27. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 1st ed. Reston, VA: American College of Radiology, 2003
                                  28. Liberman L et al: Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol. 179(1):171-8, 2002
                                  29. Vizcaíno I et al: Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. Radiology. 219(2):475-83, 2001
                                  30. Lamb PM et al: Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast. Clin Radiol. 55(1):40-4, 2000
                                  31. Leung JW et al: Multiple bilateral masses detected on screening mammography: assessment of need for recall imaging. AJR Am J Roentgenol. 175(1):23-9, 2000
                                  32. Liberman L et al: The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories. AJR Am J Roentgenol. 171(1):35-40, 1998
                                  33. Sickles EA: Management of probably benign lesions of the breast. Radiology. 193(2):582-3, 1994
                                  34. Varas X et al: Nonpalpable, probably benign lesions: role of follow-up mammography. Radiology. 184(2):409-14, 1992
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Pathology

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Definitions

                                              • Circumscribed: Well-defined margins with abrupt interface between mass and surrounding tissue
                                                • ≥ 75% of margin sharply defined on mammography
                                                  • < 25% of margin may be obscured by overlying tissue
                                                • Entire margin must be well defined on US or MR to be classified as circumscribed by those modalities
                                              • Obscured: Predominantly circumscribed mass, but ≥ 25% of margin hidden by surrounding fibroglandular tissue
                                                • Term only used for mammography (not part of US or MR lexicon)
                                              • If any portion of margin spiculated, indistinct, or microlobulated, do not classify as circumscribed or obscured
                                                • Classify based on most suspicious component

                                            IMAGING

                                            • Mammographic Findings

                                              • Ultrasonographic Findings

                                                • MR Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Natural History & Prognosis

                                                            • Treatment

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Chan HP et al: Characterization of breast masses in digital breast tomosynthesis and digital mammograms: an observer performance study. Acad Radiol. 24(11):1372-1379, 2017
                                                                  2. Nakashima K et al: Comparison of visibility of circumscribed masses on digital breast tomosynthesis (DBT) and 2D mammography: are circumscribed masses better visualized and assured of being benign on DBT? Eur Radiol. 27(2):570-577, 2017
                                                                  3. Sippo DA et al: Metastatic disease to the breast from extramammary malignancies: a multimodality pictorial review. Curr Probl Diagn Radiol. 45(3):225-32, 2016
                                                                  4. Kim SY et al: Combined use of ultrasound elastography and B-mode sonography for differentiation of benign and malignant circumscribed breast masses. J Ultrasound Med. 34(11):1951-9, 2015
                                                                  5. Berg WA et al: Multiple bilateral circumscribed masses at screening breast US: consider annual follow-up. Radiology. 268(3):673-83, 2013
                                                                  6. Mendelson EB et al: Breast Imaging Reporting and Data System, BI-RADS: Ultrasound. 2nd ed. Reston, VA: American College of Radiology, 2013
                                                                  7. Morris EA et al: Breast Imaging Reporting and Data System: BI-RADS, Magnetic Resonance Imaging. 2nd ed. Reston, VA: American College of Radiology, 2013
                                                                  8. Sickles EA et al: Breast Imaging Reporting and Data System, BI-RADS: Mammography. 5th ed. Reston, VA: American College of Radiology, 2013
                                                                  9. Boisserie-Lacroix M et al: Triple-negative breast cancers: associations between imaging and pathological findings for triple-negative tumors compared with hormone receptor-positive/human epidermal growth factor receptor-2-negative breast cancers. Oncologist. 18(7):802-11, 2013
                                                                  10. Berg WA et al: Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology. 262(2):435-49, 2012
                                                                  11. Boisserie-Lacroix M et al: Radiological features of triple-negative breast cancers (73 cases). Diagn Interv Imaging. 93(3):183-90, 2012
                                                                  12. Mahoney MC et al: Positive predictive value of BI-RADS MR imaging. Radiology. 2012;264:51-8, 2012
                                                                  13. Noroozian M et al: Digital breast tomosynthesis is comparable to mammographic spot views for mass characterization. Radiology. 262(1):61-8, 2012
                                                                  14. Glazebrook KN et al: Imaging features of carcinoid tumors metastatic to the breast. Cancer Imaging. 11:109-15, 2011
                                                                  15. Kojima Y et al: Mammography and ultrasound features of triple-negative breast cancer. Breast Cancer. 18(3):146-51, 2011
                                                                  16. Woods RW et al: The mammographic density of a mass is a significant predictor of breast cancer. Radiology. 258(2):417-25, 2011
                                                                  17. Ko ES et al: Triple-negative breast cancer: correlation between imaging and pathological findings. Eur Radiol. 20(5):1111-7, 2010
                                                                  18. Yoo JL et al: Can MR imaging contribute in characterizing well-circumscribed breast carcinomas? Radiographics. 30(6):1689-702, 2010
                                                                  19. Harvey JA et al: Short-term follow-up of palpable breast lesions with benign imaging features: evaluation of 375 lesions in 320 women. AJR Am J Roentgenol. 193(6):1723-30, 2009
                                                                  20. Kim SH et al: Correlation of ultrasound findings with histology, tumor grade, and biological markers in breast cancer. Acta Oncol. 47(8):1531-8, 2008
                                                                  21. Park YM et al: Palpable breast masses with probably benign morphology at sonography: can biopsy be deferred? Acta Radiol. 49(10):1104-11, 2008
                                                                  22. Noguera JJ et al: Metastases to the breast: a review of 33 cases. Australas Radiol. 51(2):133-8, 2007
                                                                  23. Hong AS et al: BI-RADS for sonography: positive and negative predictive values of sonographic features. AJR Am J Roentgenol. 184(4):1260-5, 2005
                                                                  24. Sickles EA et al: Performance benchmarks for diagnostic mammography. Radiology. 235(3):775-90, 2005
                                                                  25. Graf O et al: Follow-up of palpable circumscribed noncalcified solid breast masses at mammography and US: can biopsy be averted? Radiology. 233(3):850-6, 2004
                                                                  26. Lam WW et al: Sonographic appearance of mucinous carcinoma of the breast. AJR Am J Roentgenol. 182(4):1069-74, 2004
                                                                  27. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 1st ed. Reston, VA: American College of Radiology, 2003
                                                                  28. Liberman L et al: Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol. 179(1):171-8, 2002
                                                                  29. Vizcaíno I et al: Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. Radiology. 219(2):475-83, 2001
                                                                  30. Lamb PM et al: Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast. Clin Radiol. 55(1):40-4, 2000
                                                                  31. Leung JW et al: Multiple bilateral masses detected on screening mammography: assessment of need for recall imaging. AJR Am J Roentgenol. 175(1):23-9, 2000
                                                                  32. Liberman L et al: The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories. AJR Am J Roentgenol. 171(1):35-40, 1998
                                                                  33. Sickles EA: Management of probably benign lesions of the breast. Radiology. 193(2):582-3, 1994
                                                                  34. Varas X et al: Nonpalpable, probably benign lesions: role of follow-up mammography. Radiology. 184(2):409-14, 1992