What imaging feature is most concerning for malignancy: spiculated margins or smooth margins?

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Spiculated margins indicate an infiltrative, invasive process where tumor-induced desmoplastic reaction pulls on surrounding breast tissue, creating radiating lines from the lesion. This pattern is strongly associated with malignancy, especially invasive ductal carcinoma, and is much less consistent with benign processes. Smooth margins are typical of benign lesions like cysts or fibroadenomas, while circumscribed margins and lobulated margins can appear in both benign and malignant lesions but are less specific. The presence of spiculation, often with architectural distortion and sometimes suspicious calcifications, makes malignancy far more likely.