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Breast
Lesion Imaging Characteristics
Masses
Spiculated Margins
Spiculated Margins
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Stellate margins

            • Definitions

              • Sharp lines radiating from margin of mass
              • May have associated architectural distortion: Retraction of parenchyma and tethering of Cooper ligaments
                • Can be isolated finding (without central mass)

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Natural History & Prognosis

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Wu T et al: Identification of a correlation between the sonographic appearance and molecular subtype of invasive breast cancer: a review of 311 cases. Clin Imaging. 53:179-85, 2019
                                    2. Gity M et al: Diagnostic investigation of breast magnetic resonance imaging in malignant and benign mass lesions. Arch Med Sci. 14(5):1061-9, 2018
                                    3. Vijapura C et al: Imaging features of nonmalignant and malignant architectural distortion detected By Tomosynthesis. AJR Am J Roentgenol. 211(6):1397-1404, 2018
                                    4. Wen X et al: Correlations between ultrasonographic findings of invasive lobular carcinoma of the breast and intrinsic subtypes. Ultraschall Med. ePub, 2018
                                    5. 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
                                    6. Au FW et al: Histological grade and immunohistochemical biomarkers of breast cancer: correlation to ultrasound features. J Ultrasound Med. 36(9):1883-94, 2017
                                    7. Lee SH et al: Imaging features of breast cancers on digital breast tomosynthesis according to molecular subtype: association with breast cancer detection. Br J Radiol. 90(1080):20170470, 2017
                                    8. Navarro Vilar L et al: MR imaging findings in molecular subtypes of breast cancer according to BIRADS system. Breast J. 23(4):421-8, 2017
                                    9. Houssami N et al: Digital breast tomosynthesis (3D-mammography) screening: A pictorial review of screen-detected cancers and false recalls attributed to tomosynthesis in prospective screening trials. Breast. 26:119-34, 2016
                                    10. Kamal RM et al: Can we apply the MRI BI-RADS lexicon morphology descriptors on contrast-enhanced spectral mammography? Br J Radiol. 20160157, 2016
                                    11. Liu S et al: Is there a correlation between the presence of a spiculated mass on mammogram and luminal a subtype breast cancer? Korean J Radiol. 17(6):846-52, 2016
                                    12. 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
                                    13. Mendelson EB et al: Breast Imaging Reporting and Data System, BI-RADS: Ultrasound. 2nd ed. Reston, VA: American College of Radiology, 2013
                                    14. Morris EA et al: Breast Imaging Reporting and Data System, BI-RADS: MRI. 2nd ed. Reston, VA: American College of Radiology, 2013
                                    15. Sickles EA et al: Breast Imaging Reporting and Data System, BI-RADS: Mammography. 5th ed. Reston, VA: American College of Radiology, 2013
                                    16. Skaane P et al: Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology. 267(1):47-56, 2013
                                    17. Blaichman J et al: Sonographic appearance of invasive ductal carcinoma of the breast according to histologic grade. AJR Am J Roentgenol. 199(3):W402-8, 2012
                                    18. Linda A et al: Nonsurgical management of high-risk lesions diagnosed at core needle biopsy: can malignancy be ruled out safely with breast MRI? AJR Am J Roentgenol. 198(2):272-80, 2012
                                    19. Brennan ME et al: Magnetic resonance imaging screening of the contralateral breast in women with newly diagnosed breast cancer: systematic review and meta-analysis of incremental cancer detection and impact on surgical management. J Clin Oncol. 27(33):5640-9, 2009
                                    20. Wang Y et al: Estrogen receptor-negative invasive breast cancer: imaging features of tumors with and without human epidermal growth factor receptor type 2 overexpression. Radiology. 246(2):367-75, 2008
                                    21. Alexander MC et al: Association of stellate mammographic pattern with survival in small invasive breast tumors. AJR Am J Roentgenol. 187(1):29-37, 2006
                                    22. Evans AJ et al: Is mammographic spiculation an independent, good prognostic factor in screening-detected invasive breast cancer? AJR Am J Roentgenol. 187(5):1377-80, 2006
                                    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. Liberman L et al: MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. AJR Am J Roentgenol. 180(4):901-10, 2003
                                    25. Tabár L et al: The Swedish Two-County Trial twenty years later. Updated mortality results and new insights from long-term follow-up. Radiol Clin North Am. 38(4):625-51, 2000
                                    26. 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
                                    27. Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995
                                    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

                                              • Synonyms

                                                • Stellate margins

                                              • Definitions

                                                • Sharp lines radiating from margin of mass
                                                • May have associated architectural distortion: Retraction of parenchyma and tethering of Cooper ligaments
                                                  • Can be isolated finding (without central mass)

                                              IMAGING

                                              • General Features

                                                • Mammographic Findings

                                                  • Ultrasonographic Findings

                                                    • MR Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Natural History & Prognosis

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Wu T et al: Identification of a correlation between the sonographic appearance and molecular subtype of invasive breast cancer: a review of 311 cases. Clin Imaging. 53:179-85, 2019
                                                                      2. Gity M et al: Diagnostic investigation of breast magnetic resonance imaging in malignant and benign mass lesions. Arch Med Sci. 14(5):1061-9, 2018
                                                                      3. Vijapura C et al: Imaging features of nonmalignant and malignant architectural distortion detected By Tomosynthesis. AJR Am J Roentgenol. 211(6):1397-1404, 2018
                                                                      4. Wen X et al: Correlations between ultrasonographic findings of invasive lobular carcinoma of the breast and intrinsic subtypes. Ultraschall Med. ePub, 2018
                                                                      5. 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
                                                                      6. Au FW et al: Histological grade and immunohistochemical biomarkers of breast cancer: correlation to ultrasound features. J Ultrasound Med. 36(9):1883-94, 2017
                                                                      7. Lee SH et al: Imaging features of breast cancers on digital breast tomosynthesis according to molecular subtype: association with breast cancer detection. Br J Radiol. 90(1080):20170470, 2017
                                                                      8. Navarro Vilar L et al: MR imaging findings in molecular subtypes of breast cancer according to BIRADS system. Breast J. 23(4):421-8, 2017
                                                                      9. Houssami N et al: Digital breast tomosynthesis (3D-mammography) screening: A pictorial review of screen-detected cancers and false recalls attributed to tomosynthesis in prospective screening trials. Breast. 26:119-34, 2016
                                                                      10. Kamal RM et al: Can we apply the MRI BI-RADS lexicon morphology descriptors on contrast-enhanced spectral mammography? Br J Radiol. 20160157, 2016
                                                                      11. Liu S et al: Is there a correlation between the presence of a spiculated mass on mammogram and luminal a subtype breast cancer? Korean J Radiol. 17(6):846-52, 2016
                                                                      12. 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
                                                                      13. Mendelson EB et al: Breast Imaging Reporting and Data System, BI-RADS: Ultrasound. 2nd ed. Reston, VA: American College of Radiology, 2013
                                                                      14. Morris EA et al: Breast Imaging Reporting and Data System, BI-RADS: MRI. 2nd ed. Reston, VA: American College of Radiology, 2013
                                                                      15. Sickles EA et al: Breast Imaging Reporting and Data System, BI-RADS: Mammography. 5th ed. Reston, VA: American College of Radiology, 2013
                                                                      16. Skaane P et al: Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology. 267(1):47-56, 2013
                                                                      17. Blaichman J et al: Sonographic appearance of invasive ductal carcinoma of the breast according to histologic grade. AJR Am J Roentgenol. 199(3):W402-8, 2012
                                                                      18. Linda A et al: Nonsurgical management of high-risk lesions diagnosed at core needle biopsy: can malignancy be ruled out safely with breast MRI? AJR Am J Roentgenol. 198(2):272-80, 2012
                                                                      19. Brennan ME et al: Magnetic resonance imaging screening of the contralateral breast in women with newly diagnosed breast cancer: systematic review and meta-analysis of incremental cancer detection and impact on surgical management. J Clin Oncol. 27(33):5640-9, 2009
                                                                      20. Wang Y et al: Estrogen receptor-negative invasive breast cancer: imaging features of tumors with and without human epidermal growth factor receptor type 2 overexpression. Radiology. 246(2):367-75, 2008
                                                                      21. Alexander MC et al: Association of stellate mammographic pattern with survival in small invasive breast tumors. AJR Am J Roentgenol. 187(1):29-37, 2006
                                                                      22. Evans AJ et al: Is mammographic spiculation an independent, good prognostic factor in screening-detected invasive breast cancer? AJR Am J Roentgenol. 187(5):1377-80, 2006
                                                                      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. Liberman L et al: MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. AJR Am J Roentgenol. 180(4):901-10, 2003
                                                                      25. Tabár L et al: The Swedish Two-County Trial twenty years later. Updated mortality results and new insights from long-term follow-up. Radiol Clin North Am. 38(4):625-51, 2000
                                                                      26. 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
                                                                      27. Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995