Radial Scars

A radial scar is a form of sclerosing duct hyperplasia. There is typically no solid, dense central tumor corresponding to the size of the spicules. But, often there are translucent, circular, or oval regions in the center of the radiating structure which gives the radial scar a characteristic ‘star-like‘ appearance.

Radial scars may indicate a disturbance in the breast tissue and more specifically between the stromal (supportive) and functional elements (lobules, ducts, etc), that can lead to the formation of scar tissue, or possibly to cancer.

I just would like to inform you that this page is a little bit out-dated, but still very useful. However, because of that, I have decided to create a new version of this page with more up-to-date information on Radial Scars.

A radial scar moderately increases risk of breast cancer development

A finding of a radial scar is thought to be an increased risk factor for breast cancer. Women with a radial scar are thought to be at higher risk for breast cancer development, ranging from approximately 8% to 30%.

Radial scars are not seen on ultrasound

At mammography they may be detected as a kind of star-shaped feature with spiculated contours and no or little central mass. They are not detectable using ultrasound, and they are usually confirmed during biopsy.

The image below is a mammogram of a radial scar.

radialscar

Biopsy is required for confirmation and differential diagnosis

The spiculated, star-like configuration of the radial scar can resemble tubular carcinoma, so to establish a differential diagnosis, a biopsy is taken examined under a microscope. Typically one of two stains is applied to the tissue: either hematoxylin-eosin or immunohistochemical actin. A finding of healthy myoepithelial cells in the histological workup excludes the diagnosis of tubular carcinoma.

Differential diagnosis: ruling out tubular carcinoma by biopsy

The images below are histology slides of breast tissue, and show benign ducts within a sclerotic stroma, thus ruling out the possibility of tubular carcinoma. The breast tissue in both of these images has much thicker collagen (fibrous tissue), than average, and would in fact feel much harder too the touch than normal.

Hematoxylin-eosin, and staining actin

Hematoxylin-Eosin is a type of stain, applied to the tissue, which makes things look a certain way under the microscope.

scleroticstroma1-hematoxylineosin

Dr. Halls Dr. Halls
The orange collagen is much thicker than it should be.


Talking Moose
Talking Moose
Thick collagen IS what a scar is made of.



 
 

The second image uses a stain called ‘staining-actin‘, often used to find smooth muscle tissue (actin). The actin stain shows the smooth muscle as the darker-brown color where muscle cells are lining the outside of ducts (tubules).

scleroticstroma2-smoothmuscleactine

In both images above, the absence of any kind of abnormality affecting the epithelial lining of the tubules rules out tubular carcinoma, and confirms the diagnosis of radial scar.

Excisional biopsy reduces ‘false negatives’

There is some danger of ‘false negative‘ finding if the biopsy is done with very small samples, such as by fine needle aspiration or a needle core biopsy. In it not uncommon for a radial scar or complex sclerosing lesion to contain small amounts of malignant breast cancer cells. An excisional biopsy is usually recommended.


Everything you pretty much need to know about radial scars is listed above, but here are just a couple Q&A I have posted for you that are the most common… :

  • What is a radial scar of the breast? A radial scar of the breast, and also known as complex sclerosing lesion of the breast, is a benign breast lesion that can radiologically mimic malignancy (cancer).
  • What is radial scar associated with? It is associated with an increased risk of breast cancer in both breasts, not only within the breast it occurred.
  • How are radial scars diagnosed? Radial scars are diagnosed by a microscopic examination of excised tissue. For example, they are diagnosed by pathologists based on their histomorphology.
  • What is histomorphology? Radical scars are spiculated masses characterized microscopically by a sclerotic appearing (scar like) center with peripheral entrapped normal breast ducts and lobules.
  • How are radial scars managed? Radial scars are often excised to exclude malignancy. However, observation following a core biopsy may also be considered.

References

  1. Jacobs, TW et al. Abramson Cancer Center of the University of Pennsylvania.The New England Journal of Medicine Vol. 340 No. 6 p.430 February 11, 1999
  2. Tabar, Laszlo. M.D. Teaching Course in diagnostic breast imaging: Multimodality approach to the detection and diagnosis of occult breast cancer. Mammography Education, Inc. 2001.
  3. Mokbel, K., Price, R.K., Carpenter, R., Jacobs, T. W., Connolly, J. L., Schnitt, S. J. (1999). Radial Scars and Breast Cancer. NEJM 341: 210-210
  4. Brenner, R. J., Jackman, R. J., Parker, S. H., Evans, W. P. III, Philpotts, L., Deutch, B. M., Lechner, M. C., Lehrer, D., Sylvan, P., Hunt, R., Adler, S. J., Forcier, N. (2002). Percutaneous Core Needle Biopsy of Radial Scars of the Breast: When Is Excision Necessary?. Am. J. Roentgenol. 179: 1179-1184
  5. Douglas-Jones, A., Denson, J., Cox, A., Harries, I., Stevens, G., Radial scar lesions of the breast diagnosed by needle core biopsy: analysis of cases containing occult malignancy. J Clin Pathol 2007;60:295-298

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