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Mammographically detected spicules associated with malignant breast tumors frequently harbor additional tumor foci

Heli Tuomainen

Heli Tuomainen

  • Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University HospitalKuopio, Finland
  • Clinical Radiology, Institute of Clinical Medicine, School of Medicine, University of Eastern FinlandKuopio, Finland
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Tuomainen, Heli
, 
Mazen Sudah

Mazen Sudah

  • Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University HospitalKuopio, Finland
  • Clinical Radiology, Institute of Clinical Medicine, School of Medicine, University of Eastern FinlandKuopio, Finland
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Sudah, Mazen
, 
Sarianna Joukainen

Sarianna Joukainen

Department of Plastic Surgery, Division of Surgery, Kuopio University HospitalKuopio, Finland
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Joukainen, Sarianna
, 
Vesa Kärjä

Vesa Kärjä

Department of Clinical Pathology, Diagnostic Imaging Center, Kuopio University HospitalKuopio, Finland
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Kärjä, Vesa
, 
Amro Masarwah

Amro Masarwah

Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University HospitalKuopio, Finland
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Masarwah, Amro
, 
Otto Jokelainen

Otto Jokelainen

  • Department of Clinical Pathology, Diagnostic Imaging Center, Kuopio University HospitalKuopio, Finland
  • Pathology and Forensic Medicine, Institute of Clinical Medicine, School of Medicine, University of Eastern FinlandKuopio, Finland
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Jokelainen, Otto
 and 
Hidemi Okuma

Hidemi Okuma

  • Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University HospitalKuopio, Finland
  • Clinical Radiology, Institute of Clinical Medicine, School of Medicine, University of Eastern FinlandKuopio, Finland
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Okuma, Hidemi
  
Jun 21, 2025
Mammographically detected spicules associated with malignant breast tumors frequently harbor additional tumor foci's Cover Image
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Article Category: research article
Published Online: Jun 21, 2025
Page range: 168 - 175
Received: Dec 19, 2024
Accepted: Apr 07, 2025
DOI: https://doi.org/10.2478/raon-2025-0041
Keywords
© 2025 Heli Tuomainen et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1.

A 14 mm spiculated invasive ductal carcinoma (IDC) excised en bloc with spiculations. A tomosynthesis specimen radiogram at the level of the tumor documents the total removal of both the guidewire localized tumor (A; arrow) and the associated spicules (arrowheads). The histopathological analysis (B, H&E; 10 × magnification) showed that all the spicules contained additional tumors: the spicule shown in the red box contained IDC (100 × magnification); one spicule contained ductal carcinoma in situ (DCIS) (blue box, 150 × magnification); other spicules contained both DCIS and IDC in green (100 × magnification) and yellow (150 × magnification) boxes.
A 14 mm spiculated invasive ductal carcinoma (IDC) excised en bloc with spiculations. A tomosynthesis specimen radiogram at the level of the tumor documents the total removal of both the guidewire localized tumor (A; arrow) and the associated spicules (arrowheads). The histopathological analysis (B, H&E; 10 × magnification) showed that all the spicules contained additional tumors: the spicule shown in the red box contained IDC (100 × magnification); one spicule contained ductal carcinoma in situ (DCIS) (blue box, 150 × magnification); other spicules contained both DCIS and IDC in green (100 × magnification) and yellow (150 × magnification) boxes.

Figure 2.

A mammogram of a nonpalpable, spiculated 12 mm invasive ductal carcinoma: a craniocaudal-tomosynthesis view (A) demonstrates spiculations better than full-field digital mammography in mediolateral-projection (B). After breast conserving surgery, a more superficial axial section (C) the invasive additional cancer extends 2.2 mm from the tumor’s margin. In the deeper section (D) additional invasive cancer cells are visible further in the spicule extending up to 2.7 mm from the tumor’s margin highlighting that analyzing only one section of a spicule will underestimate the extent of the disease. (E) A magnified view of the base of the spicule.
A mammogram of a nonpalpable, spiculated 12 mm invasive ductal carcinoma: a craniocaudal-tomosynthesis view (A) demonstrates spiculations better than full-field digital mammography in mediolateral-projection (B). After breast conserving surgery, a more superficial axial section (C) the invasive additional cancer extends 2.2 mm from the tumor’s margin. In the deeper section (D) additional invasive cancer cells are visible further in the spicule extending up to 2.7 mm from the tumor’s margin highlighting that analyzing only one section of a spicule will underestimate the extent of the disease. (E) A magnified view of the base of the spicule.

Figure 3.

(A) A mediolateraloblique spot magnification view of a 13 mm mainly circumscribed, mixed papillary and invasive ductal carcinoma (arrows) with a few spicules (arrowheads). The histopathologal analysis (B) showed a single solid spicule with multiple foci, likely representing a continuum of low-grade ductal carcinoma in situ (arrows) extending as far as 10.1 mm from the tumor’s edge and close to the resection margin.
(A) A mediolateraloblique spot magnification view of a 13 mm mainly circumscribed, mixed papillary and invasive ductal carcinoma (arrows) with a few spicules (arrowheads). The histopathologal analysis (B) showed a single solid spicule with multiple foci, likely representing a continuum of low-grade ductal carcinoma in situ (arrows) extending as far as 10.1 mm from the tumor’s edge and close to the resection margin.

Presence and distribution of spicules in the pre- and intraoperative images

Pre (%) Intra (%) P value (r*)
Number of spicules 12.2 ± 6.3 13.0 ± 6.2 < 0.001 (0.577)
Maximum length of spicules (mm) 7.3 ± 5.0 9.5 ± 5.1 < 0.001 (0.564)
Presence of spicules 0.648
 Yes 97 (59.9) 100 (61.7)
 No 65 (40.1) 62 (38.3)
Radial distribution of spicules 0.192
 < 25 % 8 (8.2) 7 (7.0)
 25–50 % 23 (23.7) 22 (22.0)
 50–75 % 21 (21.6) 18 (18.0)
 75–100 % 45 (46.4) 53 (53.0)

Characteristics of the patients and tumors

Number (%)
Patients 156
Lesions 162
Mean age, years (range) 63.0 ± 10.2 (33–95)
Histology
 Invasive ductal 125 (77.2)
 Invasive lobular 29 (17.9)
 Others* 8 (4.9)
Size of tumor, mm (range) 16.2 ± 10.0 (2–60)
Grade
 1 51 (31.5)
 2 87 (53.7)
 3 24 (14.8)
T-stage
 T1 122 (75.3)
 T2 38 (23.5)
 T3 2 (1.2)
N-stage
 N0 117 (72.2)
 N1 39 (24.1)
 N2 5 (3.1)
 N3 1 (0.6)
ER status
 Positive 149 (92.0)
 Negative 13 (8.0)
PR status
 Positive 144 (88.9)
 Negative 18 (11.1)
HER-2 status
 Positive 11 (6.8)
 Negative 151 (93.2)
Ki-67 status
 Lower (≤ 14 %) 60 (37.0)
 Higher (> 14 %) 101 (62.3)
 Data missing 1 (0.6)

Distribution of tumor subtypes and presence of additional tumor material in spicules in relation to spiculated mass

Spiculated (%) Non-spiculated (%) P value
Subtype
 Luminal A 28 41.2 32 34.0 0.016
 Luminal B 39 57.4 46 48.9
 HER-2 enriched 1 1.5 8 8.5
 Basal 0 0 8 8.5
Presence of additional tumor in spicules
 Yes 46 67.6 46 48.9 0.018
 No 22 32.4 48 51.1

Mammographic features of the tumors and the lesion descriptions according to Breast Imaging Reporting and Data System (BI-RADS) 5th

Breast composition Number (%)
 A 49 (30.2)
 B 84 (51.9)
 C 26 (16.0)
 D 3 (1.9)
Findings
 Mass 128 (79.0)
 Calcification 25 (15.4)
 Architectural distortion 6 (3.7)
 Asymmetry 2 (1.2)
 Invisible on mammography 1 (0.6)
Mass shape
 Oval 14 (10.9)
 Round 61 (47.7)
 Irregular 53 (41.4)
Mass margin
 Circumscribed 3 (2.3)
 Obscured 3 (2.3)
 Microlobulated 31 (24.2)
 Indistinct 23 (18.0)
 Spiculated 68 (53.1)
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English
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Journal Subjects:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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