Radial sclerosing lesions (RSLs) are benign breast lesions defined by fibroelastosis, which causes entrapment of epithelial elements within the stroma (Figure 1) [3]

Fig 1: Distortion of architecture in mammography (A), which corresponds to a radiated lesion according to its pathological anatomy (B).

Radiologically, radial scars feature a central fibroelastic core with ducts radiating outward, creating a stellate appearance on imaging studies. CSLs, in contrast, are larger with a more complex architecture [1]. RSLs are often incidentally discovered during mammography, where they typically appear stellate or spiculated, with distortion and central lucency (Figure 2) [4]

Fig 2: CC (A) and MLO (B) projection with tomosynthesis. An architectural distortion is visualized at the junction of the upper quadrants of the right breast, with a radiolucent center and long spicules (arrows) that converge towards it.

On ultrasound (US), RSLs are frequently not identified unless targeted evaluations are conducted after mammographic findings [1]. Their visibility on ultrasound is critical for enabling guided histological assessment, which aids in clinical management options, including imaging follow-up, surgical interventions, or percutaneous aspiration.

In this study, our objective was to analyze RSLs subjected to ultrasound-guided biopsy, detailing the characteristic sonographic signs, evaluating the ability of ultrasound to predict atypia or malignancy, and calculating the histological underestimation between core biopsy results and definitive pathology in surgically excised cases.