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Findings: In the superolateral aspect of the right breast, there is a 3 cm area of architectural distortion with peripheral spiculation and central lucency. There are no suspicious calcifications associated with it. The finding is optimally visualized on the craniocaudal and true lateral views.

Diagnosis: Radial scar.

Discussion: Radial scar is a benign lesion of the breast. It is a common pathologic finding, but not frequently seen on mammograms. It is almost always clinically asymptomatic. Its etiology is unknown; however, it is not related to prior surgery or trauma.

Mammographically, most radial scars are seen as spiculated masses or focal areas of architectural distortion with multiple long thin spicules and a central area of lucency. Invasive carcinoma has a similar appearance and, therefore, one cannot differentiate between a radial scar and malignancy.

The spiculated and/or distorted appearance of a radial scar is secondary to central fibrosis and elastosis causing retraction. Fat may be entrapped in the center of the lesion causing the central lucency seen on the mammograms.

An excisional biopsy should be performed in suspected cases of radial scar rather than a needle biopsy because of the known association with both premalignant and malignant lesions. Also, it can be difficult to distinguish between a radial scar and tubular carcinoma histologically.

References:
Bassett LW, et al. Diagnosis of Diseases of the Breast.
Philadelphia, W. B. Saunders Co., 1977.

Kapans DB. Breast Imaging. Philadelphia, J.B. Lippincott Company, 1989.

Frouge C, et al. Mammographic Lesions Suggestive of Radial Scars:
Microscopic Findings in 40 Cases. Radiology 1995; 623-625.

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