Sclerosing adenosis is difficult to distinguish from invasive ductal carcinoma and biopsy is mandatory. However, if you see enough of these lesions and compare the images carefully with mammographic and ultrasound images, you will begin to notice the fact that the lesion is relatively low density in the center. There is a huge surrounding spiculated response but in relation to that there is actually very little happening in the center.
The diagnosis is still made with biopsy. But you can get a very good indication of the diagnosis if you look at these lesions carefully enough.