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Indistinct Margins
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Ill-defined, poorly defined margins
            • Definitions

              • Mammography: Demarcation between mass and surrounding tissue is not clearly defined
                • Any suggestion of poor margin definition raises possibility of tumor infiltration
                • Distinguish from "obscured" margins masked by overlapping tissue
                  • If any portion of margin is indistinct, margin is indistinct
                • Distinguish from focal asymmetry
                  • Spot compression views or tomosynthesis may reveal persistent, indistinctly marginated mass
              • US: No clear demarcation between mass and surrounding tissue
                • Most important distinction: At least portion of mass margin is not circumscribed
                • May also have echogenic rim surrounding mass, suspicious finding
              • MR: Unsharp margin
                • Blooming sign: Mass margin initially sharp, then becomes indistinct as contrast washes out over several minutes; suspicious finding

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          CLINICAL ISSUES

                          • Presentation

                            DIAGNOSTIC CHECKLIST

                            • Image Interpretation Pearls

                              Selected References

                              1. Woodard GA et al: Qualitative radiogenomics: association between Oncotype DX test recurrence score and BI-RADS mammographic and breast MR imaging features. Radiology. 286(1):60-70, 2018
                              2. Bitencourt AGV et al: Breast metastases from extramammary malignancies: multimodality imaging aspects. Br J Radiol. 90(1077):20170197, 2017
                              3. Wienbeck S et al: Radiological imaging characteristics of intramammary hematological malignancies: results from a German multicenter study. Sci Rep. 7(1):7435, 2017
                              4. Sannomiya N et al: Correlation between ultrasound findings of tumor margin and clinicopathological findings in patients with invasive ductal carcinoma of the breast. Yonago Acta Med. 59(2):163-8, 2016
                              5. An YY et al: Breast cancer in very young women (< 30 years): Correlation of imaging features with clinicopathological features and immunohistochemical subtypes. Eur J Radiol. 84(10):1894-902, 2015
                              6. Elverici E et al: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol. 21(3):189-94, 2015
                              7. Scoggins ME et al: Correlation between sonographic findings and clinicopathologic and biologic features of pure ductal carcinoma in situ in 691 patients. AJR Am J Roentgenol. 204(4):878-88, 2015
                              8. Yang Q et al: Ultrasonographic features of triple-negative breast cancer: a comparison with other breast cancer subtypes. Asian Pac J Cancer Prev. 16(8):3229-32, 2015
                              9. Çelebi F et al: The role of ultrasonographic findings to predict molecular subtype, histologic grade, and hormone receptor status of breast cancer. Diagn Interv Radiol. 21(6):448-53, 2015
                              10. Park VY et al: Additional malignant breast lesions detected on second-look US after breast MRI vs. additional malignant lesions detected on initial US in breast cancer patients: comparison of US characteristics. Ultraschall Med. 35(5):432-9, 2014
                              11. Irshad A et al: Assessing the role of ultrasound in predicting the biological behavior of breast cancer. AJR Am J Roentgenol. 200(2):284-90, 2013
                              12. Tan JZ et al: Mucinous carcinomas of the breast: imaging features and potential for misdiagnosis. J Med Imaging Radiat Oncol. 57(1):25-31, 2013
                              13. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                              14. Sickles EA et al: Breast Imaging Reporting and Data System: BI-RADS, Mammography. 5th ed. Reston: American College of Radiology, 2013
                              15. Boisserie-Lacroix M et al: Radiological features of triple-negative breast cancers (73 cases). Diagn Interv Imaging. 93(3):183-90, 2012
                              16. Dietzel M et al: Magnetic resonance mammography of invasive lobular versus ductal carcinoma: systematic comparison of 811 patients reveals high diagnostic accuracy irrespective of typing. J Comput Assist Tomogr. 34(4):587-95, 2010
                              17. 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
                              18. Berg WA et al: Breast Imaging Reporting and Data System: inter- and intraobserver variability in feature analysis and final assessment. AJR Am J Roentgenol. 174(6):1769-77, 2000
                              19. 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
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Top Differential Diagnoses

                                    • Pathology

                                      • Diagnostic Checklist

                                        TERMINOLOGY

                                        • Synonyms

                                          • Ill-defined, poorly defined margins
                                        • Definitions

                                          • Mammography: Demarcation between mass and surrounding tissue is not clearly defined
                                            • Any suggestion of poor margin definition raises possibility of tumor infiltration
                                            • Distinguish from "obscured" margins masked by overlapping tissue
                                              • If any portion of margin is indistinct, margin is indistinct
                                            • Distinguish from focal asymmetry
                                              • Spot compression views or tomosynthesis may reveal persistent, indistinctly marginated mass
                                          • US: No clear demarcation between mass and surrounding tissue
                                            • Most important distinction: At least portion of mass margin is not circumscribed
                                            • May also have echogenic rim surrounding mass, suspicious finding
                                          • MR: Unsharp margin
                                            • Blooming sign: Mass margin initially sharp, then becomes indistinct as contrast washes out over several minutes; suspicious finding

                                        IMAGING

                                        • General Features

                                          • Mammographic Findings

                                            • Ultrasonographic Findings

                                              • MR Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        DIAGNOSTIC CHECKLIST

                                                        • Image Interpretation Pearls

                                                          Selected References

                                                          1. Woodard GA et al: Qualitative radiogenomics: association between Oncotype DX test recurrence score and BI-RADS mammographic and breast MR imaging features. Radiology. 286(1):60-70, 2018
                                                          2. Bitencourt AGV et al: Breast metastases from extramammary malignancies: multimodality imaging aspects. Br J Radiol. 90(1077):20170197, 2017
                                                          3. Wienbeck S et al: Radiological imaging characteristics of intramammary hematological malignancies: results from a German multicenter study. Sci Rep. 7(1):7435, 2017
                                                          4. Sannomiya N et al: Correlation between ultrasound findings of tumor margin and clinicopathological findings in patients with invasive ductal carcinoma of the breast. Yonago Acta Med. 59(2):163-8, 2016
                                                          5. An YY et al: Breast cancer in very young women (< 30 years): Correlation of imaging features with clinicopathological features and immunohistochemical subtypes. Eur J Radiol. 84(10):1894-902, 2015
                                                          6. Elverici E et al: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol. 21(3):189-94, 2015
                                                          7. Scoggins ME et al: Correlation between sonographic findings and clinicopathologic and biologic features of pure ductal carcinoma in situ in 691 patients. AJR Am J Roentgenol. 204(4):878-88, 2015
                                                          8. Yang Q et al: Ultrasonographic features of triple-negative breast cancer: a comparison with other breast cancer subtypes. Asian Pac J Cancer Prev. 16(8):3229-32, 2015
                                                          9. Çelebi F et al: The role of ultrasonographic findings to predict molecular subtype, histologic grade, and hormone receptor status of breast cancer. Diagn Interv Radiol. 21(6):448-53, 2015
                                                          10. Park VY et al: Additional malignant breast lesions detected on second-look US after breast MRI vs. additional malignant lesions detected on initial US in breast cancer patients: comparison of US characteristics. Ultraschall Med. 35(5):432-9, 2014
                                                          11. Irshad A et al: Assessing the role of ultrasound in predicting the biological behavior of breast cancer. AJR Am J Roentgenol. 200(2):284-90, 2013
                                                          12. Tan JZ et al: Mucinous carcinomas of the breast: imaging features and potential for misdiagnosis. J Med Imaging Radiat Oncol. 57(1):25-31, 2013
                                                          13. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                                                          14. Sickles EA et al: Breast Imaging Reporting and Data System: BI-RADS, Mammography. 5th ed. Reston: American College of Radiology, 2013
                                                          15. Boisserie-Lacroix M et al: Radiological features of triple-negative breast cancers (73 cases). Diagn Interv Imaging. 93(3):183-90, 2012
                                                          16. Dietzel M et al: Magnetic resonance mammography of invasive lobular versus ductal carcinoma: systematic comparison of 811 patients reveals high diagnostic accuracy irrespective of typing. J Comput Assist Tomogr. 34(4):587-95, 2010
                                                          17. 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
                                                          18. Berg WA et al: Breast Imaging Reporting and Data System: inter- and intraobserver variability in feature analysis and final assessment. AJR Am J Roentgenol. 174(6):1769-77, 2000
                                                          19. 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