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Review
. 2021 Jun;126(6):774-785.
doi: 10.1007/s11547-021-01344-w. Epub 2021 Mar 20.

Radial Scar: a management dilemma

Charlotte Marguerite Lucille Trombadori #  1 , Anna D'Angelo #  2 , Francesca Ferrara  3 , Angela Santoro  4 , Paolo Belli  5 , Riccardo Manfredi  3   5
Affiliations
Review

Radial Scar: a management dilemma

Charlotte Marguerite Lucille Trombadori et al. Radiol Med. 2021 Jun.

Abstract

Radial scar (RS) or complex sclerosing lesions (CSL) if > 10 mm is a benign lesion with an increasing incidence of diagnosis (ranging from 0.6 to 3.7%) and represents a challenge both for radiologists and for pathologists. The digital mammography and digital breast tomosynthesis appearances of RS are well documented, according to the literature. On ultrasound, variable aspects can be detected. Magnetic resonance imaging contribution to differential diagnosis with carcinoma is growing. As for the management, a vacuum-assisted biopsy (VAB) with large core is recommended after a percutaneous diagnosis of RS due to potential sampling error. According to the recent International Consensus Conference, a RS/CSL lesion, which is visible on imaging, should undergo therapeutic excision with VAB. Thereafter, surveillance is justified. The aim of this review is to provide a practical guide for the recognition of RS on imaging, illustrating radiological findings according to the most recent literature, and to delineate the management strategies that follow.

Keywords: B3-lesions; Radial scar; Radial scar management; Vacuum-assisted biopsy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Surgical specimen shows typical aspect of RS: lesion with stellate architecture, prominent fibroelastosis with basophilic elastic material, obliterated ducts, compressed tubular structures with two cell layers (including myoepithelium, CK14 +) and hyalinized stroma. (Hematoxylin–eosin stain [H&E]; magnification × 4)
Fig. 2
Fig. 2
“Black Star”: Left craniocaudal (a) and mediolateral oblique (b) mammograms show an area of architectural distortion with radiolucent core in the union of upper quadrants (white circle). Left mediolateral oblique tomosynthesis (c) confirms the area of architectural distortion and shows better the radiolucent core with the radiating long thin spicules (white circle)
Fig. 3
Fig. 3
“Black Star”: Right craniocaudal (a) and mediolateral oblique (b) mammograms show an area of architectural distortion with radiolucent core in the upper-outer quadrant (white circle). Right mediolateral oblique tomosynthesis (c) shows better the architectural distortion and the radiolucent core (white circle)
Fig. 4
Fig. 4
“White Star”: Left craniocaudal (a) and mediolateral oblique (b) mammograms reveal a stellate opacity with ill-defined borders and spiked linear extensions (white circle) in the upper- inner quadrant. Radiopaque metallic landmark was positioned before surgery
Fig. 5
Fig. 5
Right craniocaudal (a) and mediolateral oblique (b) mammograms show an area of microcalcifications with in the upper-outer quadrant (white circle)
Fig. 6
Fig. 6
US demonstrates an irregularly shaped hypoechoic distorted parenchymal area, showing ill-defined borders, with posterior acoustic shadowing (white arrow)
Fig. 7
Fig. 7
US shows a mass with circumscribed margins without posterior acoustic shadowing (white arrow)
Fig. 8
Fig. 8
US shows a focal area of shadowing with no discernible mass (white arrow)
Fig. 9
Fig. 9
Sagittal MRI contrast material-enhanced T1-weighted image (a) and axial MRI subtracted early contrast-enhanced image (b) show an enhancing mass with irregular borders (white circle)
Fig. 10
Fig. 10
Axial MRI precontrast T1-weighted image (a), early contrast-enhanced T1-weighted image (b) and early T1-weighted subtraction show an architectural distortion without enhancement (white circle)
See this image and copyright information in PMC

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