Researchers looked at mammogram images from 161 women with a specific type of breast cancer that appears spiky or jagged on X-rays. They measured how much of the image was spiky compared to the solid tumor itself. While they found that women with more spikiness tended to be older and have less dense breast tissue, the spikiness didn’t clearly predict whether cancer would spread or how long patients would survive. This study suggests that how spiky a cancer looks might not be as important for predicting outcomes as doctors once thought, and more research is needed to understand what these patterns really mean.

The Quick Take

  • What they studied: Whether the amount of spiky edges around a breast cancer tumor on mammogram images could predict how aggressive the cancer would be and how well patients would do
  • Who participated: 161 women (average age 68, ranging from 55-91 years old) who had breast cancer with spiky-looking edges on their mammograms, followed between 2004-2014
  • Key finding: The ratio of spiky edges to solid tumor size was not significantly linked to cancer survival or spread to lymph nodes, though it was associated with patient age and breast tissue density
  • What it means for you: If you have spiculated breast cancer, the spikiness pattern alone probably won’t determine your prognosis. Your doctor will need to look at other factors like hormone receptor status and tumor grade to predict outcomes. This finding suggests doctors shouldn’t rely solely on spiculation patterns when planning treatment.

The Research Details

This was a retrospective study, meaning researchers looked back at medical records and images from women who had already been diagnosed and treated. They examined mammogram images from 161 women with spiculated breast cancer (cancer with spiky-looking edges) collected between 2004-2014. Radiologists carefully traced the outline of the solid tumor and the spiky areas around it on the images. They then calculated a ratio by dividing the total area (tumor plus spikes) by just the tumor area alone—they called this the SMR or spiculation-to-mass ratio. The researchers then grouped women into three categories based on whether they had low, medium, or high SMR values and looked for patterns.

This approach is important because it’s one of the first times researchers have tried to measure spiculation patterns in a standardized way rather than just describing them as ‘spiky’ or ’not spiky.’ By creating a measurable ratio, scientists can compare results across different patients and studies. However, because this is exploratory research in a single center, the findings need to be confirmed by other researchers before doctors change how they interpret mammograms.

This study has some important limitations to understand: it’s a single-center study (only one hospital), it’s retrospective (looking backward at old records), and it’s exploratory (testing new ideas rather than confirming established ones). The sample size of 161 is moderate but not huge. The researchers used appropriate statistical tests, but because they looked at many different factors, some findings might have occurred by chance. The study was well-designed for an exploratory investigation, but the results should be considered preliminary rather than definitive.

What the Results Show

The main finding was that the spiculation-to-mass ratio (SMR) was NOT significantly associated with breast cancer survival or whether cancer had spread to lymph nodes under the arm. This was surprising because doctors had suspected that more extensive spiculation might indicate a less aggressive cancer. The researchers did find that SMR was significantly associated with two factors: women with higher SMR values tended to be older, and they tended to have less dense breast tissue (which is actually common in older women anyway). When the researchers looked at the nine women with the very highest SMR values, they noticed these women were all negative for axillary lymph node involvement (meaning cancer hadn’t spread to underarm lymph nodes), were positive for estrogen receptors (a good prognostic sign), and had low Ki67 scores (a marker of slower-growing cancer). However, because this was only nine women, these observations are preliminary.

The study found no significant associations between SMR and several other important cancer characteristics including tumor size, estrogen receptor status, progesterone receptor status, HER2 status, histological grade, or cancer type. The lack of associations with these factors suggests that spiculation patterns develop independently from these other cancer features. The finding that SMR was associated with age and breast density is likely explained by normal changes in breast tissue as women age, rather than reflecting something unique about the cancer itself.

Previous research has suggested that spiculated breast cancers are often less aggressive than cancers with other appearances on mammograms. This study partially supports that idea—the women with the most extensive spiculation did show some favorable characteristics (no lymph node involvement, hormone receptor positivity). However, this study found that the degree of spiculation alone doesn’t reliably predict survival or cancer spread, suggesting that the relationship between appearance and aggressiveness is more complex than previously thought. The findings suggest doctors need to look at multiple factors together rather than relying on spiculation patterns alone.

Several important limitations should be considered: First, this is a single-center study from one hospital in Sweden, so results might not apply everywhere. Second, it’s retrospective, meaning researchers couldn’t control how mammograms were taken or measured. Third, the measurement of spiculation was done by eye rather than by computer, which could introduce human error. Fourth, the study is exploratory, so it’s testing new ideas rather than confirming established ones—the findings need confirmation. Fifth, the sample size of 161 is moderate, and when looking at many different factors, some associations might occur by chance. Finally, the nine women with very high SMR values is too small a group to draw firm conclusions about what extensive spiculation means.

The Bottom Line

Based on this research, doctors should NOT use spiculation patterns alone to predict breast cancer outcomes or aggressiveness. Instead, treatment decisions should continue to be based on established prognostic factors like tumor grade, hormone receptor status, HER2 status, and lymph node involvement. If you have spiculated breast cancer, ask your doctor about these other factors rather than focusing on how spiky the tumor appears. More research is needed before spiculation patterns can be reliably used in clinical decision-making.

This research is most relevant to women with spiculated breast cancer and their doctors. Radiologists who interpret mammograms should be aware that spiculation patterns alone may not be as predictive as previously thought. Women without breast cancer don’t need to worry about this finding. Women with other types of breast cancer (non-spiculated) should not assume these findings apply to them.

This is preliminary research, so don’t expect immediate changes in how doctors interpret mammograms. It typically takes 5-10 years of additional research to confirm findings and change clinical practice. If you’re currently being treated for spiculated breast cancer, this research shouldn’t change your treatment plan—your doctor will use established prognostic factors to guide decisions.

Want to Apply This Research?

  • If you have a history of breast cancer, track your regular mammogram appointments and results in the app. Record the date of each mammogram, any findings noted by the radiologist, and your follow-up appointments. This helps you maintain a personal health timeline and ensures you don’t miss screening appointments.
  • Use the app to set reminders for annual or biennial mammogram screening based on your doctor’s recommendations. Create a notification system that alerts you 2-3 months before your scheduled screening is due. This ensures consistent monitoring regardless of spiculation patterns.
  • Maintain a long-term record of all mammogram results and pathology reports in your health profile. Track any changes in breast density over time and note any new findings. Share this information with your healthcare provider at each visit to ensure comprehensive, continuous care monitoring.

This research is preliminary and exploratory in nature. The findings should not be used to make individual medical decisions about breast cancer diagnosis, treatment, or prognosis. If you have been diagnosed with breast cancer or have concerns about mammogram findings, consult with your oncologist or radiologist who can evaluate your specific situation. Spiculation patterns alone should not be used to determine treatment decisions—your doctor will consider multiple factors including tumor grade, hormone receptor status, and other established prognostic markers. This article is for educational purposes only and does not replace professional medical advice.