- Еуромедик, Булевар уметности 29, Београд
Radial scar
Др Владимир Урбан
Прим др Милош Почековац
A radial breast scar is not actually a scar, but a benign proliferative lesion with radially distributed ducts, sclerosis, and central fibroelastosis. When it is larger than 10 mm, it is also called complex sclerosing lesion, and the common name for both entities is radial sclerosing lesion. Which is why a tissue sample taken by biopsy from the center of the lesion may be negative. Excision is therefore recommended for all cases of radial scar.
It occurs most often between the ages of 40 and 60. Radiologically, it is significant because it often looks like squamous cell carcinoma on mammography and ultrasound, so these two diagnoses cannot be reliably differentiated by these methods alone. Although it is a histologically benign lesion, it is clinically significant because in a certain percentage of cases it is associated with malignancy or atypical ductal hyperplasia. Carcinomas are often located on the periphery.
A radial scar does not cause symptoms, it is usually not palpable or retracts the skin.
Mammographically, it manifests itself as asymmetry, distortion or a spiculated shadow. Long, thin spicules are typical for a radial scar, without a clearly defined central mass, often with central illumination – if it is on a dense background, it is described as a “black star”. However, lightening within the radial scar does not exclude malignancy. It is often seen only in one projection or looks different in different projections. Sometimes there are also microcalcifications, usually punctiform or amorphous.
Ultrasound can manifest as a distortion without a clearly separated mass, a heterogeneous echostructure with small hypoechoic nodulations on the periphery or as an irregular hypoechoic mass with or without posterior attenuation; if it is associated with malignancy, it can be more noticeable on ultrasound1).
Tubular carcinoma, invasive ductal or lobular carcinoma and a true scar are considered in the differential diagnosis.
Irregular hypoechoic lesion with unclear edges, size about 11 mm, with distortion of the surrounding tissue, without a clearly formed mass, without pronounced posterior phenomena and without vascular signals.
Black star, visible only in CC projection.