Spiculated Masses on Mammography

The differential diagnosis of a spiculated mass on mammography includes:

• Scar from biopsy: Most common etiology.
• Radial scar: Usually lacks central density. Thin radiolucent lines can be seen coursing through its center. May contain microcalcifications. Indistinguishable from tubular carcinoma on imaging.
• Fat necrosis: May contain microcalcifications.
• Abscess
• Hematoma
• Tuberculosis
• Sclerosing adenosis: May contain microcalcifications. May be difficult to differentiate from tubular carcinoma on histological evaluation.
• Cancer:

A hematoma or abscess may be suspected based on history and may resolve or decrease in size on short-term (1-month) follow-up. A scar at a recent biopsy site may also be followed to evaluate stability or partial resolution. Otherwise, the benign causes cannot be differentiated from neoplasm, and biopsy is often needed.

References

• Sickles EA. Breast masses: mammographic evaluation. Radiology. 1989 Nov;173(2):297-303.
• Cyrlak D, Carpenter PM, Rawal NB. Breast imaging case of the day. Florid sclerosing adenosis. Radiographics. 1999 Jan-Feb;19(1):245-7.