Screening mammography: a surgeon's strategy for dealing with abnormal mammographic findings

Screening mammography is a valuable tool in the detection of breast cancer at an early stage. Large numbers of patients are being referred to surgeons for biopsies on the basis of mammographic abnormalities alone. As mammograms are complex studies and the findings often subtle, variation in terms of interpretation and recommendations for biopsy can leave the surgeon in a difficult position. We have reported a systematic method for evaluating patients and mammograms. Eighty-eight patients were referred to a single surgeon solely for an abnormal mammographic finding. Physical examination was repeated and the mammogram reviewed with a single consulting radiologist using specific criteria to define a mammographic abnormality. Through this evaluation, biopsy was avoided in 42 of 88 patients, with follow-up mammograms and physical examinations finding no suspicion of malignancy. By becoming educated in regard to mammographic abnormalities, establishing specific criteria with a consistent radiologist, and following patients carefully who are not biopsied, the surgeon can deal effectively with screening mammography.     

Abnormal mammographic findings. A critical appraisal

We performed a 1 year review of mammographic interpretations and breast biopsy experiences at Madigan Army Medical Center, correlating biopsy results with mammographic interpretations when possible. Fibrocystic mammary dysplasia was reported in two thirds of our patients, with interpretations heavily weighted toward findings of moderate or severe dysplasia. Sixteen percent of our patients had indeterminate or suspicious mammograms, and only 11 percent of the mammograms were read as normal. Of 19 patients who underwent needle-directed biopsy for nonpalpable lesions and suspicious or indeterminate mammograms, two had invasive cancer and one lobular carcinoma in situ. Our data suggest that many patients who have indeterminate mammograms are followed in preference to early biopsy if there is no palpable lesion and no high yield radiologic criteria of malignancy.     

The impact of mammography on breast biopsy.

To determine the efficacy of mammography in the detection of early breast carcinoma at an urban teaching hospital, the results of all breast biopsies performed between 1983 and 1987 that were preceded by mammographic examination were retrospectively reviewed. There were 503 women in this population. Malignancy was detected in 79 cases (15.7%); 21 were in situ and 58 were invasive. Among all nonpalpable malignancies, 53.0 per cent were in situ, while only 2.4 per cent of all palpable malignancies were in situ. An abnormality was found in 374 mammograms (74%), and 73 (19.5%) were malignant. The abnormality most likely to represent a malignancy (44% yield) was spiculated density, followed by clustered microcalcifications (25%), mass (22%), and asymmetric density (14%). Six malignancies were detected by biopsy for clinical indications, despite a negative mammogram (4.7% false- negative rate). The interpretation of mammograms by radiologists carried a 2.4 per cent false-negative rate. The mammographic features of mass, clustered microcalcifications, spiculations or asymmetric density should generally mandate breast biopsy, although the clinical examination should remain an important basis for management decisions. An aggressive approach toward screening mammography and breast biopsy based on mammographic criteria may enhance survival among women with breast carcinoma.     

Changing patterns of care for occult breast lesions in a community teaching hospital

We performed a retrospective analysis of 384 consecutive stereotactic breast biopsies (SBBs) from March 1995 through January 1999 and compared it with our historical breast biopsy experience. Two hundred forty-four patients underwent biopsies for microcalcifications and 135 patients for abnormal mammographic densities. Pathology diagnoses included 302 patients with benign disease, 35 patients with atypical ductal hyperplasia, 4 patients with lobular carcinoma in situ, 29 patients with ductal carcinoma in situ, and 9 patients with invasive breast cancer. These diagnostic rates were compared with our prior needle-localized pathology findings. For the study period, the number of mammograms, open biopsies, and needle-localized biopsies remained stable. The number of SBBs, however, increased progressively in every year. Medicare reimbursement for SBB was $921.19, and for breast biopsy after needle localization, $1566.22. Our study strongly suggests that the availability of SBB has significantly lowered the threshold for recommending biopsy of abnormal mammograms. The increased utilization of SBB almost certainly indicates an increase in the overall cost of breast care. This cost must be balanced against substantial potential benefits of this minimally invasive technique: possible earlier diagnosis of atypical and precancerous lesions, patient reassurance in cases of uncertain mammographic interpretation, and a reduced need for follow-up of indeterminate mammograms.     

Benign diagnosis by image-guided core-needle breast biopsy

Image-guided core-needle breast biopsy (IGCNBB) is widely used to evaluate patients with abnormal mammograms; however, information is limited regarding the reliability of a benign diagnosis. The goal of this study was to demonstrate that a benign diagnosis obtained by IGCNBB is accurate and amenable to mammographic surveillance. Records of all patients evaluated by IGCNBB from July 1993 through July 1996 were reviewed. Biopsies were classified as malignant, atypical, or benign. All benign cases were followed by surveillance mammography beginning 6 months after IGCNBB. Of the 1110 patients evaluated by IGCNBB during the study period, 855 revealed benign pathology. A total of 728 of the 855 patients (85%) complied with the recommendation for surveillance mammography. A total of 196 IGCNBBs were classified as malignant; 59 cases were classified as atypical. The atypical cases were excluded from the statistical analysis. Only two patients have demonstrated carcinoma after a benign IGCNBB during the 2-year minimum follow-up period. The sensitivity and specificity of a benign result were 100.0 and 98.9 per cent, respectively. A benign diagnosis obtained by IGCNBB is accurate and therefore amenable to mammographic surveillance. The results of this study support IGCNBB as the preferred method of evaluating women with abnormal mammograms.     

Is Screening Detected Bilateral Axillary Adenopathy on Mammography Clinically Significant?

Our objective was to retrospectively review the incidence and outcome of asymptomatic patients recalled from screening due to bilateral axillary adenopathy (BAxA) with an otherwise normal mammogram. This study included all women recalled from screening due to BAxA that underwent ultrasound guided biopsy between July 2004 and April 2010. Women with a known etiology for adenopathy were excluded. One radiologist blinded to biopsy outcome evaluated mammographic lymph node characteristics. Twelve of 74,926 screening mammograms (0.016%) performed during the study period met inclusion criteria. Five women (41.7%) had non‐Hodgkin lymphoma (NHL); two had long axis dimension of <20 mm, but had prior mammograms demonstrating an increase in size and density of the lymph nodes. There were no significant differences in lymph node characteristics between benign and malignant results. This study finds a high positive predictive value for malignancy for BAxA when no etiology is apparent. We propose that patients with BAxA as the sole mammographic abnormality undergo further imaging and clinical evaluation as this may indicate significant pathology.     

Elemental analysis and clinical implications of calcification deposits associated with silicone breast implants

Calcification of the fibrous capsule surrounding silicone breast implants is a well-recognized occurrence that increases with time following implantation. These mineralized deposits potentially confound mammographic breast cancer surveillance already made difficult by the obscuring effects of silicone breast implants. The authors performed elemental analysis of silicone breast implant-associated calcifications to define better their chemical composition as related to mammographic and clinical significance. Electron probe microanalysis and infrared spectroscopy revealed all of the calcification deposits to be calcium complexed with tribasic phosphate. No evidence of calcium oxalate, calcium carbonate, silicone, or talc was observed. Caution must be employed in interpreting mammograms in women with silicone breast implants as well as those who have had their silicone breast implants removed. High-density mammographic calcifications indicative of calcium phosphate associated with a silicone breast implant may represent an accepted consequence of implantation or nearby carcinoma. We recommend baseline mammography on women who have had their silicone breast implants removed to prevent unnecessary fine-needle aspiration or tissue biopsy of retained breast capsule calcifications during subsequent routine surveillance for carcinoma.     

The natural history of mammographic calcifications subjected to interval follow-up.

The purpose of this investigation was to determine the natural history and risk of malignancy associated with isolated indeterminate microcalcifications subjected to interval follow-up. During a 2-year study, 91 patients were identified with indeterminate microcalcifications alone. Specific roentgenographic features of the calcifications were evaluated on initial and follow-up mammograms. During a mean follow-up of 36 months, 19 (21%) of the women exhibited mammographic changes. Ten patients (11%) with suspicious changes underwent a needle-directed biopsy 6 to 30 months after the initial mammographic screening. Five women (5.5%) were diagnosed as having breast carcinoma; three had invasive ductal carcinoma and two had purely intraductal lesions. Four patients had axillary lymph node dissections and no metastatic disease was found. We found no significant differences in the roentgenographic features associated with malignant vs benign lesions apart from an increased overall estimation of the probability of malignancy rating in the five patients with breast carcinoma. We recommend that patients be followed up with mammography at regular intervals for at least 18 months following recognition of indeterminate microcalcifications.     

Early experience with needle localization and biopsy of mammographic lesions

Increasing awareness of the value of mammography by both physicians and the public has resulted in women presenting more commonly with impalpable breast lesions. This study reviews the radiology and pathology of 58 such lesions biopsied by the Monash Medical Centre Breast Unit between August 1987 and October 1988. Abnormal mammograms were reported by one of two independent radiologists in the normal course of practice and placed into one of five categories according to the radiological appearance. Those lesions scoring greater than or equal to 3 were then needle localized, excised and examined histologically. All mammograms were later reported as unknowns by the other radiologist and similarly scored. Sixteen (28%) of these lesions were invasive or in situ carcinoma and of these a significant number were scored differently by the two radiologists. The results indicate that needle localization biopsy of suspicious mammographic lesions is a safe, accurate method for the diagnosis of early breast cancer. The results also show significant variation between radiologists and demonstrate the need for double reading of screening mammographic films. It is suggested that doubtful lesions require more extensive work-up with compression/magnification and other special views, the aim being more accurate radiological assessment and a reduction in the benign biopsy rate.     

A better understanding of the term radial scar

BACKGROUND: Radial scar is a breast lesion with mammographic and histologic features similar to carcinoma. We reviewed the characteristics of patients with radial scars to better understand these lesions and to determine the incidence of associated carcinoma. METHODS: Records for all patients undergoing diagnostic wire localized excisional breast biopsy from January 1993 to September 1999 were reviewed to identify those with histologic or mammographic evidence of radial scar. Clinical records, mammograms, and pathologic slides of these patients were reviewed. RESULTS: We identified 45 cases of radial scar: 10 patients had mammographic and histologic evidence of radial scar (group I), 29 only mammographic evidence (group II), and 6 only histologic evidence (group III). Breast cancer risk was similar in the three patient groups. Carcinoma was identified in 18 patients with mammographic radial scars. CONCLUSION: Mammographically detected radial scars were associated with carcinoma in 18 of 39 (46%) cases. Histologically identified radial scars are not associated with malignancy and should not be confused with mammographically identified lesions.     

Mammographic screening in women at increased risk of breast cancer after treatment of Hodgkin's disease

Treatment regimens for Hodgkin's disease (HD) that have included radiation to lymph node regions in the thorax have contributed to high rates of long-term disease-free survival. However, incidental radiation exposure of breast tissue in young women has significantly increased the risk of breast cancer compared to expected rates in the general population. After informing patients about risks associated with previous treatment of HD, we studied screening mammograms and call-back rates in women at increased risk for developing breast cancer at a younger age. We contacted by mail a cohort of 291 women between 25 and 55 years of age who had received thoracic irradiation before 35 years of age for HD with or without chemotherapy. Subjects were offered information about risks identified after HD therapy with questionnaires to assess response to this information. Ten patients refused participation, 93 did not respond, and 21 were excluded after they reported a prior diagnosis of invasive (1) or in situ (2) breast cancer. One hundred and sixty seven women received information about secondary breast cancer risk and were advised to initiate or maintain mammographic screening. Available mammograms were reviewed by two radiologists and classified according to the ACR BI-RADS Mammography Lexicon. Abnormal findings were correlated to pathology results from biopsies. One hundred and fifteen subjects reported that they obtained new mammograms during the period of the study. Ninety-nine were available for secondary review. Patients were studied an average of 16.9 years after HD treatment (Range: 4.5-32.5 years) at an average of 41 years of age (range 25-55 years). High density breast tissue was identified in 60% (60/99). Seventeen of the women (17.2%) were recalled for further imaging. This was more common in women with heterogeneously dense breast tissue. Seven of those recalled (41%) were advised to undergo biopsies that identified ductal carcinoma in situ (DCIS) in one and benign findings in the others. Among 16 women whose mammograms were unavailable for review, three were diagnosed with DCIS; two of these had microscopic evidence of invasive breast cancer. The four in situ or microinvasive cancers were diagnosed in the study participants at 25-40 years of age and from 5 to 23 years after HD therapy. Biopsies were performed because mammograms detected microcalcifications without palpable abnormality in three of these cases. Women who have had thoracic nodal irradiation for Hodgkin's disease have an increased risk of developing secondary breast cancer at an unusually young age. As expected in younger women, high density breast tissue was common on mammography, and the recall and biopsy rates were unusually high. However, early mammographic screening facilitated diagnosis of in situ and early invasive cancer in 3.5% of our subjects.     

Invasive mammary carcinoma after immediate and short-term follow-up for lobular neoplasia on core biopsy

Lobular neoplasia (LN), including atypical lobular hyperplasia (ALH) and lobular carcinoma in situ, may be encountered in breast core biopsies performed for mammographic abnormalities even though LN is often not, in itself, responsible for the abnormal mammogram. The need for surgical excision following a diagnosis of LN on core biopsy is not well defined. We examined pathologic and mammographic findings in a consecutive series of cases diagnosed as LN to address this issue. Radiology/pathology records were reviewed for cases with a pathology diagnosis of pure LN during the period 1998-2001. Specifically excluded were cases with associated atypical ductal hyperplasia, ductal carcinoma in situ, invasive mammary carcinoma, or any history of breast malignancy. Thirty-five women 39-76 years of age (mean 52 years) were identified. Specimens were obtained as stereotactic core (31) or limited wire-guided biopsy (four). The diagnoses were lobular carcinoma in situ (12), lobular carcinoma in situ/ALH (10), and ALH (13). Fourteen patients did not undergo excisional biopsy and had no subsequent clinical follow-up to warrant additional biopsy (follow-up 6 months to 3 years). Five patients had no immediate excision, but eventually during clinical follow-up for LN (1 month to 3 years), two developed mammographic lesions in the ipsilateral (one patient) or contralateral breast (one patient) that led to diagnoses of invasive mammary carcinoma (lobular and composite ductal-lobular types, 10 and 8 mm, respectively); three patients had subsequent mammographic findings in the ipsilateral or contralateral breast leading to biopsies showing only LN (two patients) or no neoplastic pathology (one patient). The remaining 16 patients (all core biopsied) underwent immediate wire-guided excisions. Thirteen (81%) showed additional foci of LN, one (6.3%) with atypical ductal hyperplasia, and two (12.5%) with invasive lobular carcinoma (3 mm and <1 mm). Three (19%) had no residual disease; however, additional clinical follow-up in one of these patients revealed an invasive mammary carcinoma in the contralateral breast (false-negative mammography). Radiographic findings were calcifications and density/mass lesions in 27 and 8 cases, respectively. Of 27 cases presenting with Ca, 10 showed colocalization of LN and Ca. In the eight cases presenting with density/mass, incidental microscopic microcalcifications colocalized to LN were found in two cases. When present, histologic Ca was associated with LN in 12 of 29 cases studied (41%). Of the 21 patients with immediate or subsequent excision, five (24%) were found to have an associated invasive mammary carcinoma (two on immediate excision and three after short-term follow-up of up to 3 years). The bilaterality of cancer risk was expected; however, the number of invasive carcinomas was not. That the invasive carcinomas detected at follow-up were small implies that they might have been present (but occult) at initial presentation. We conclude that lobular carcinoma in situ detected on core biopsy is potentially a significant marker for concurrent and near-term breast pathology requiring complete intensive multidisciplinary clinical follow-up with specific individualization of patient care.     

Assessment of non-palpable mammographic abnormalities: comparison between screening and symptomatic clinics.

A retrospective study found that a breast screening clinic generated fewer localization biopsies for non-palpable mammographic abnormalities than a symptomatic clinic (3.36 versus 9.89 per 1000 mammograms, respectively) and that a greater proportion of such biopsies were malignant. This study determined the reason for this difference. There were 108 of 304 (35.5 per cent) and 17 of 130 (13.1 per cent) carcinomas in women attending the screening and breast clinics respectively (relative risk 2.72 (95 per cent confidence interval 1.70-4.34)). This difference was regardless of age. The characteristics of the mammographic abnormality, the Wolfe pattern, a family history of breast carcinoma, parity and age at first pregnancy were similar in both groups. Women attending the screening clinic were referred for localization biopsy after assessment by clinicians and radiologists at a joint clinic; there was no joint assessment for patients attending the breast clinic. The same staff attended both clinics, although the proportion of time spent at each varied. This study suggests that all women with a non-palpable mammographic abnormality should be reviewed at a joint assessment clinic before localization biopsy is recommended.     

Nonpalpable breast lesions at biopsy. A detailed analysis of radiographic features.

Several studies have demonstrated that mammographic screening of asymptomatic women results in a lower mortality rate where breast cancer is concerned. Often, screening mammograms reveal a nonpalpable radiographic abnormality and the diagnosis must be determined by an excisional biopsy after radiographic needle localization. The mammographic features associated with 179 nonpalpable breast abnormalities biopsied after radiographic needle localization were carefully characterized. There were 41 carcinomas (23%) in the series. The aim of this study was to determine which radiographic findings, if any, strongly portend the presence of either a malignant or benign lesion. Mammographic features that were commonly associated with malignancy include a change from a previous mammogram, a distortion of the surrounding architecture, the association of a soft tissue density and calcifications, and the presence of more than ten calcifications in the lesion. The radiographic abnormalities which were more commonly associated with benign disease include well-defined densities without calcifications, asymmetric densities without calcifications, and abnormalities consisting solely of a focus of mammographic calcifications that have fewer than ten concretions. The incidence of malignancy in lesions having these mammographic characteristics was only 5.5%. On the basis of these results alone, no firm threshold for biopsy can be recommended. The risks of deferring biopsy until there is worsening of the mammographic image remains to be determined.     

NEWLY ARISING FIBROADENOMAS IN WOMEN AGED 35 AND OVER

Background: Fifty-one cases of de novo fibroadenoma in women aged 35 years and older were found during an analysis of 117 729 visits to the Wesley Breast Clinic from 1990 to 1996. Methods: The clinical, mammographic and ultrasound diagnosis of fibroadenoma was confirmed by either fine needle aspiration cytology or histology of an open biopsy specimen. In all cases there was a well-documented previous visit available for review, at which there was no clinical or radiological evidence of the fibroadenoma. Results: Thirty-seven of the de novo fibroadenomas were palpable, the remainder satisfying strict mammographic and/or ultrasound criteria. Four of the new fibroadenomas were in women aged 50–52. Conclusions: This study provides information about the natural history of fibroadenomas, confirming that they can appear for the first time in middle-aged women. This has important clinical implications, since new lesions appearing in women over 35 have tended to be automatically categorized as suspicious of carcinoma. However, a multidisciplinary approach involving clinical examination, mammography, ultrasound, and fine needle aspiration cytology or core biopsy can result in a confident diagnosis of fibroadenoma. This will allow some women with new lesions to be managed conservatively rather than by open biopsy.     

Outcome of surgery for non-palpable mammographic abnormalities

Four hundred and ninety-three women underwent 515 localization biopsies for non-palpable mammographic abnormalities. The mammographic abnormality was located with a hooked wire in 509 cases. Specimen radiology was performed on all excised tissue. The mammographic abnormality was visualized in the first piece of tissue excised in 402 (78.1 per cent) cases and complete excision was achieved in 476 (92.4 per cent). A palpable nodule was removed in 38 (7.4 per cent) cases and in 17 (44.7 per cent) was shown to contain a carcinoma. The mammographic abnormality was missed in 14 (2.7 per cent) cases or only partly excised in 13 (2.5 per cent). Overall 144 (28.0 per cent) localization biopsies were malignant. The mammographic abnormality was not visualized on the specimen radiograph more frequently in women aged under 55 years, in women with dense breast (Wolfe grade DM or DY) or in those whose mammographic abnormality contained only microcalcification. The 27 women in whom the mammographic abnormality was not visible on the specimen radiograph underwent repeat mammography 2 months later. Only two women required a further localization biopsy and the mammographic abnormality was recovered in the first piece of tissue excised. Women with a carcinoma underwent mastectomy or wide local excision, and residual carcinoma at the localization biopsy site was found in 64 (44.4 per cent) cases. Oestrogen receptor analysis by ligand binding assay was possible in only 71 (49.3 per cent) carcinomas. If the specimen radiograph does not show the mammographic abnormality within pieces of tissue excised and there is no palpable nodule it may be best to conclude the biopsy. In this series these missed lesions were usually benign. Only rarely is a second localization biopsy required and this is performed without difficulty.     

A multimodality approach to the diagnosis of breast hamartomas with atypical mammographic appearance

Abstract: The ultrasonographic appearance of breast hamartomas (BHs) is described and its diagnostic utility is discussed in this study of 27 women with mammographic findings both typical and atypical of BH. The role of computed tomography (CT) in the diagnosis of BH of atypical mammographic appearance is also analyzed. These 27 cases of BH were detected in women submitted to mammographic screening. Ages ranged from 45 to 65 years (mean age 52.6 years). In all cases physical and ultrasonographic examinations were carried out. CT studies were carried out in seven cases. Core biopsy was performed in 18 cases of lesions with a mammographic appearance atypical of BH. Lesions were palpable in 9 cases and nonpalpable in 18. Mammographic appearance was characteristic in nine cases. In 19 cases a hypoechoic solid mass with hyperechoic lines and/or bands was seen. This ultrasonographic image is suspicious of BH. Finally, both CT and core biopsy findings were of great help in the diagnosis of BH in the cases where mammographic and ultrasonographic studies were inconclusive. We consider that a combination of mammography, ultrasonography, CT, and core biopsy is fundamental for the successful diagnosis of breast hamartomas not seen in typical form in mammograms.     

CORE BIOPSY FOR MICROCALCIFICATIONS IN THE BREAST

Background : The conventional method of dealing with clustered mammographic microcalcification in the breast when it is of uncertain aetiology is to undertake either a short-term mammographic review or to surgically excise the abnormal area and submit it for histological examination. Stereotactic wide-bore needle biopsy (core biopsy) of microcalcifications is a suitable alternative to surgical biopsy and experience with this technique forms the basis of the present study. Methods : Percutaneous core biopsy has been used at the Wesley Breast Clinic as a means of assessing clustered calcification in 297 cases from November 1992 to October 1995. The procedure is done under local anaesthesia as an outpatient procedure using a Stereotactic attachment to a standard mammography unit. Results : A diagnosis of frank malignancy was made on core samples in 22 cases (7.4%), and in all of these malignancy was confirmed at open surgical biopsy. In a further six women in whom the core biopsy was reported as ‘suspicious of malignancy’, open surgical biopsy confirmed malignancy in three women, lobular in situ carcinoma was found in two women, and atypical ductal hyperplasia in one woman. In two instances the core sample was reported as showing atypical ductal hyperplasia and in those cases, this was confirmed at open surgical biopsy. In 265 cases (89%) the histology of the core revealed appearances of benign breast tissue. Open surgical biopsy has been undertaken in only six of these cases, but in all instances the histology has confirmed a benign process. In the two remaining cases, the procedure was considered to be technically unsatisfactory, and open surgical biopsy was recommended because of doubt about the appearance of the microcalcification. In both instances, malignancy was demonstrated. Conclusions : Core biopsy of clustered mammographic microcalcification of uncertain aetiology is recommended as a satisfactory and reliable alternative to open surgical biopsy. It is less expensive, can be done quickly, produces few complications, and does not produce subsequent mammographic distortion.     

All pure flat atypical atypia lesions of the breast diagnosed using percutaneous vacuum-assisted breast biopsy do not need surgical excision

BackgroundThe purposes of this study were to evaluate the outcome of women with pure flat atypical atypia (FEA) diagnosed at vacuum-assisted breast biopsy (VABB) targeting microcalcifications and to determine whether clinical, radiological and pathologic parameters are able to predict which lesions will be upgraded to malignancy.Materials2414 cases of consecutive VABB for microcalcifications using VA 8-, 10- or 11-Gauge stereotactically guided core biopsy performed between January 2005 and December 2011 from two french breast cancer centers were evaluated. Data of women with VABB-diagnosed pure FEA who underwent either excisional surgery or mammographic follow-up were analyzed. Cases with mass lesions or ipsilateral cancers were excluded. Two pathologists (FA,PM) reviewed the results of procedures performed. Clinical, radiological, as well as histological criteria have been studied in order to determine the correlation between these factors and carcinoma underestimation.Results and conclusionThis study included 70 cases of pure FEA. Twenty women underwent surgical excision and 50 had clinical and mammographic surveillance only. In three women FEA was upgraded to breast cancer on excision. Clinical and mammographic follow-up for a mean of 56 months ± 27 in the group without excision showed two cancers in the same breast (Intermediate grade DCIS, and invasive ductal carcinoma 84 and 48 months respectively after VABB). Three factors were significantly predictive of underestimation or occurence of cancer for pure FEA when the radiologic lesions are calcifications: age≥ 57 years, radiologic size >10 mm and number of FEA foci ≥4.     

Multicentric Secretory Carcinoma of the Breast in a 35-Year-Old Woman: Mammographic Appearance and the Use of Core Biopsy in Preoperative Management

Abstract: Core biopsy of the breast has been increasingly utilized as a first-line diagnostic approach for mammographic breast lesions, palpable breast lesions, or both. Core biopsy has been shown to be cost-effective in sparing a significant fraction of women an open surgical procedure and, in conjunction with radiologic imaging studies, can allow for planning of definitive therapy in women with malignant lesions ( 1 - 4 ). We present a case of multicentric secretory carcinoma of the breast in which the diagnosis was suggested by core biopsy. This case represents the first reported instance of core biopsy in secretory carcinoma, one of the rarest types of mammary carcinoma. We describe the mammographic appearance of the lesion, the appearance of the tissue core, and the use of core biopsy in the proper preoperative management of this rare, multicentric lesion.