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Association of Stellate Mammographic Pattern with Survival in Small Invasive Breast Tumors

M. Camille Alexander1, Bonnie C. Yankaskas2 and Karl W. Biesemier3

1 Department of Breast Imaging, CentraHealth/Virginia Baptist Hospital, 1330 Oak Ln., Suite 202, Lynchburg, VA 24503.
2 Department of Radiology, CB 7515, Chapel Hill, NC 27599-7515.
3 Pathology Consultants of Central Virginia, Lynchburg, VA 24501.


Figure 1
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  		Fig. 1A —75-year-old woman with 0.7-cm stellate infiltrating ductal carcinoma. Mediolateral oblique magnification view. Fine, long, radiating spicules extend from central tumor mass.

 

Figure 2
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  		Fig. 1B —75-year-old woman with 0.7-cm stellate infiltrating ductal carcinoma. Craniocaudal magnification view. Spicules can be seen but are faint and subtle.

 

Figure 3
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  		Fig. 2A —67-year-old woman with 0.7-cm stellate infiltrating ductal carcinoma. Left craniocaudal view. Vague density with questionable distortion (arrowhead) is all that can be seen in this view.

 

Figure 4
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  		Fig. 2B —67-year-old woman with 0.7-cm stellate infiltrating ductal carcinoma. Left mediolateral oblique view. Architectural distortion (arrowhead) without central mass is more apparent.

 

Figure 5
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  		Fig. 3 —56-year-old woman with 1.0-cm round infiltrating ductal carcinoma. Note indistinct borders (arrowheads).

 

Figure 6
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  		Fig. 4 —61-year-old woman with multiple clusters of crushed stone-type calcifications. Histologic findings indicated the calcifications represented high-nuclear grade ductal carcinoma in situ with an associated 0.2-cm poorly differentiated infiltrating ductal carcinoma that was occult on imaging.

 

Figure 7
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  		Fig. 5 —39-year-old woman with casting calcifications associated with a 0.9-cm infiltrating ductal carcinoma. A small number of rod-shaped calcifications stream away (left arrowhead) from more clustered group (right arrowhead). Patient has bone and chest wall metastasis.

 

Figure 8
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  		Fig. 6 —Frequency distribution for mammographic categories and breast cancer-specific deaths. White bars illustrate number of women assigned to each prognostic group and black bars show number of women within that category who died of breast cancer. Bars indicate proportional frequency of mammographic category compared with proportional frequency of cancer death within that category. Women with stellate cancers comprised the largest group but had the fewest number of deaths.

 

Figure 9
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  		Fig. 7 —Worst-case scenario Kaplan-Meier survival curve when unknown cause of death within stellate group (dashed line) is assumed to be breast cancer. The stellate group fares significantly better. Solid line represents survival curve for all other groups.

 

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