From the Guidelines
A 1cm spiculated mass on a mammogram is highly suggestive of malignancy and requires prompt follow-up with a breast specialist, as this finding has a high positive predictive value for cancer and necessitates thorough evaluation. According to the most recent guidelines from the National Comprehensive Cancer Network (NCCN) 1, a spiculated mass is categorized as BI-RADS 5, which indicates a high probability of malignancy (≥ 95%). The next steps should include additional imaging, such as diagnostic mammogram views, ultrasound, and possibly MRI, to better characterize the lesion.
- Key considerations in the evaluation of a spiculated mass on mammogram include:
- The spiculated appearance is caused by cancer cells inducing a desmoplastic reaction in surrounding tissue, creating a characteristic star-like appearance on imaging.
- While not all spiculated masses are malignant, this finding has a high positive predictive value for cancer and requires thorough evaluation.
- A biopsy will likely be necessary to determine if the mass is cancerous, typically involving a core needle biopsy guided by ultrasound or stereotactic mammography.
- Early detection and treatment of breast cancer significantly improve outcomes, emphasizing the importance of prompt follow-up and evaluation.
The American College of Radiology (ACR) Appropriateness Criteria also support the use of diagnostic mammography and targeted-breast ultrasound in the evaluation of a palpable mass, with biopsy indicated when a suspicious finding is identified 1. In cases where imaging findings are suspicious for malignancy, image-guided core biopsy is warranted, with core biopsy demonstrating superior sensitivity, specificity, and correct histological grading compared to fine-needle aspiration biopsy (FNAB) 1.
From the Research
Mammogram Findings
- A 1cm spiculated lesion on a mammogram can be caused by both benign and malignant processes, including sclerosing adenosis, postsurgical scar, radial scar, tuberculosis, posttraumatic oil cysts, infiltrating ductal carcinoma, ductal carcinoma in situ, infiltrating lobular carcinoma, and tubular carcinoma 2
- Mammographically, such lesions are often similar, and only some can be differentiated on the basis of morphologic characteristics 2
Diagnostic Approaches
- Ultrasound-guided core needle biopsy is a common procedure for diagnosing suspicious breast lesions, with a high sensitivity value of about 97.5% 3
- This technique offers many advantages, including non-ionising radiation, low cost, full control of the needle in real time, accessibility in difficult locations, multidirectional punctures, and excellent comfort for patients and radiologists 3
- Ultrasound-guided vacuum-assisted core needle breast biopsy is also an accurate and useful diagnostic method that enables sufficient amounts of tissue to be obtained with minimal invasion and few complications 4
Importance of Correlation
- Clinical breast examination, additional mammographic views, and needle or surgical biopsy are often required to make a specific diagnosis, as mammography alone is frequently not reliable 2
- Adequate radiological-pathological correlation is necessary to minimize false-negative results 3
- The demand for breast teams is to carefully adhere to the principles of triple assessment and imaging-histologic correlation, and follow-up of lesions with a specific benign histology after biopsy 5