Goals: 1) to illustrate the various patterns of presentations on digital breast tomosynthesis (DBT) of pathologically-proven radial scar (RS) without associated atypia; 2) to emphasize that benign RS can mimic invasive carcinoma on DBT images; 3) to show mammographic, sonographic and Magnetic Resonance Imaging (MRI) correlation for each pattern of DBT presentation, focusing on differences between DBT and DM.

Radial scar (RS) of the breast has been previously described in the literature under several different names such as radial sclerosing lesion, scleroelastotic lesion, indurative mastopathy, nonencapsuled sclerosing lesion, sclerosing papillary proliferation, and, if larger than 1.0 cm, complex sclerosing lesion. RS is a benign breast lesion characterized by a central fibroelastotic core with ducts and lobules radiating outward, living the lesion its characteristic stellate appearance (Fig. 1). Pathologic examination of a RS reveals the presence of a diverse array of pathologic entities located at...

According to our experience RS are better visualized and evaluated on DBT than DM (Fig. 2). DBT is also able to identify RS that are occult on DM, in particular in case of dense breast tissue (Fig 3,4). According to our experience RS show three DBT patterns (Fig. 5): Pattern 1: * Architectural distortion (Fig. 6-9), with or without associated microcalcifications. The most typical appearance of RS presenting as architectural distortion (“black star”) on mammography has been described by Tabar and Dean, including: central radiolucency;...

RS detection increased dramatically over the past few years. In our experience DBT is better than DM in the detection of RS. This might depend on the planar configuration of RS, which may have varying appearances on orthogonal views. Benign RS can have several appearances on DBT. The spectrum of DBT presentations spans from occult lesions to spiculate opacities, indistinguishable from invasive carcinoma. Appreciation of these diverse appearances might help avoid misdiagnosis when evaluating DBT examinations. However, the differential diagnosis between RS and malignancy can...

Elisa Zanelli, MD Institute of Radiology,Departments of Medical and Biological Sciences University of Udine 33100 UDINE ITALY [email protected]

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