Learning objectives
Review imaging appearances of radial scars on contrast enhanced mammography (CESM)
Explore the role of CESM in the pre-treatment characterisation and subsequent management of radial scars
Correlate radial scar ultrasound appearances in local practice with the literature
Background
Contrast enhanced spectral mammography (CESM) is gaining popularity as an adjunct diagnostic tool in breast imaging, combining 2D digital mammography with the administration of intravenous contrast.
It enables evaluation of lesion enhancement associated with neovascularity as a marker of clinically relevant breast disease, similar to MRI.
It is of comparable sensitivity to breast MRI with a high negative predictive value and lower rate of false positive findings [1].
It is accessible, affordable and time efficient with very few contra-indications.
CESM is used in screening assessment...
Imaging findings OR Procedure details
A list of 55 patients with a histological diagnosis of radial scar on core biopsy since the introduction of CESM into local practice in 2014 was obtained from the BreastScreen WA database.
Imaging of all 55 patients was reviewed and core biopsy histology of 9 patients who underwent CESM as part of their management pathways correlated with final pathology at excision (results are summarised in figure 1).
[Fig 1]
In the majority of patients radial scars were seen as stellate opacities on 2D mammography and...
Conclusion
In this small series radial scars of the breast demonstrate variable enhancement on CESM, similar to MRI. It is well documented that absence of enhancement of radial scars on MRI has a high negative predictive value for malignancy at excision [2].
The overall negative predictive value of CESM is also documented in the literature [1,5,6] although no published series has been found specifically evaluating the enhancement of radial scars on CESM. Testing the hypothesis that radial scars demonstrate similar enhancement on CESM as on MRI...
References
1. Ghaderi KF, Phillips J, Perry H, Lotfi P, Mehta TS. Contrast enhanced mammography: current applications and future directions. Radiographics. 2019 November-December; Volume 39(no 7): 1907-1920.
2. Cohen MA, Newell MS. Radial scars of the breast encountered at core biopsy: review of histologic, imaging, and management considerations. AJR. 2017 November; Volume 209(no 5): 1168-1177.
3. Trombadori CML, D’Angelo A, Ferrara F, Santoro A, Belli P, Manfredi R. Radial scar: a management dilemma. Radiol Med. 2021 March 20. Available from https://doi.org/10.1007/s11547-021-01344-w.
4. Alsharif S, Aldis A,...