Architectural distortion on screening mammogram, suspected radial scar / complex sclerosing lesion
Recommended: Diagnostic Mammogram + Tomosynthesis + Targeted Ultrasound; Stereotactic biopsy is the preferred imaging study for architectural distortion on screening mammogram, suspected radial scar / complex sclerosing lesion. Stellate appearance can mimic invasive cancer.
Recommended study
Diagnostic Mammogram + Tomosynthesis + Targeted Ultrasound; Stereotactic biopsy
Stellate appearance can mimic invasive cancer. Often associated with atypia (ADH, ALH) or malignancy.
If the default doesn't apply
Surgical excision after core biopsy
Excisional biopsy regardless of core result (per most centers)
No contrast
Watch-outs
Upgrade rate to malignancy
~5-10% upgrade rate on excision; most centers excise even after benign core biopsy.
Pearls
- Stellate lesion with central lucency (radial scar specifically).
- Complex sclerosing lesion = larger (> 10 mm) variant.
- BI-RADS 4 — biopsy mandatory.