Tuomainen Heli, Sudah Mazen, Joukainen Sarianna, Kärjä Vesa, Masarwah Amro, Jokelainen Otto, Okuma Hidemi
1Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
2Clinical Radiology, Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland.
Radiol Oncol. 2025 Jun 21;59(2):168-175. doi: 10.2478/raon-2025-0041. eCollection 2025 Jun 1.
On imaging, malignant breast masses are commonly associated with spicules. To the best of our knowledge, the clinical significance of such spiculae has not been previously studied, and no surgical guidelines are available for the management of mammographically detected spiculations.
Between April 2018 and December 2019, all consecutive breast-conserving surgery -patients with invasive malignant lesions, who required intraoperative radiological breast specimen assessment with tomosynthesis, were retrospectively included in this analysis. The tumors were classified into two groups: those with spiculated margins as the dominant feature, and those with other distinct morphological characteristics. Spicule visualization, length, and distribution were evaluated in both groups using pre- and intraoperative imaging and compared with the histopathological features of the spicules.
In total, 162 invasive lesions were evaluated. The presence of spicule-associated additional tumor foci was a common finding; 67.6% of the spiculated tumors and 48.9% of the other tumors had additional foci. Most additional tumor foci were within 1 cm of the tumor edge. The mean pathologically measured distance from the main tumor margin to the spicule-associated additional tumor foci was 4.3 ± 2.8 mm. Compared to the maximum spicule length determined from intraoperative images (9.5 ± 5.1 mm), the distance of actual tumor infiltration was much shorter, and a very weak correlation was observed.
Breast tumor spicules harbor additional tumor foci, which may lead to margin positivity and potential reoperation. Additional research is necessary to determine the actual tumor burden and clinical significance of spicules.
在影像学检查中，恶性乳腺肿块通常伴有毛刺征。据我们所知，此前尚未对这种毛刺征的临床意义进行研究，且对于乳腺钼靶检查发现的毛刺征，尚无手术管理指南。
回顾性纳入2018年4月至2019年12月期间所有接受保乳手术且患有浸润性恶性病变、术中需要进行乳腺断层合成标本放射学评估的患者。将肿瘤分为两组：以毛刺状边缘为主要特征的肿瘤，以及具有其他明显形态特征的肿瘤。使用术前和术中影像评估两组的毛刺可视化、长度和分布，并与毛刺的组织病理学特征进行比较。
共评估了162个浸润性病变。伴有毛刺的额外肿瘤灶很常见；67.6%的毛刺状肿瘤和48.9%的其他肿瘤有额外病灶。大多数额外肿瘤灶位于肿瘤边缘1厘米范围内。从主要肿瘤边缘到与毛刺相关的额外肿瘤灶的平均病理测量距离为4.3±2.8毫米。与术中影像确定的最大毛刺长度（9.5±5.1毫米）相比，实际肿瘤浸润距离要短得多，且观察到的相关性非常弱。
乳腺肿瘤毛刺包含额外肿瘤灶，这可能导致切缘阳性和潜在的再次手术。需要进一步研究以确定毛刺的实际肿瘤负荷和临床意义。
