Mammographic pattern of microcalcifications in the preoperative diagnosis of comedo ductal carcinoma in situ: histopathologic correlation.

OBJECTIVE: The comedo subtype of ductal carcinoma in situ (DCIS) is more aggressive than noncomedo DCIS. Differentiating noncomedo DCIS from the more aggressive comedo subtypes on mammography would allow the surgeon to excise comedo DCIS with a wider margin. The mammographic features of microcalcifications associated with nonpalpable comedo DCIS, noncomedo DCIS and benign disease were compared to determine the usefulness of this finding in diagnosis of comedo DCIS. METHODS: The authors retrospectively and blindly reviewed the mammograms of 91 consecutive patients in whom DCIS was diagnosed by needle localization and surgical excision. An equal number of cases of benign microcalcifications were also reviewed. Microcalcifications were evaluated with respect to pattern, density, configuration and size. These results were correlated with the pathologic findings. RESULTS: All 16 cases (100%) of linear branching calcifications and 34 (80%) of the 43 cases of linear calcifications were associated with comedo DCIS (p < 0.001). The number of calcifications, the density and the size of clustering were not diagnostic of comedo DCIS. Granular calcifications occurred in noncomedo DCIS and in benign disease associated with noncalcifying DCIS. CONCLUSION: Comedo DCIS is suggested by the presence of linear and linear branching microcalcifications on mammography.     

Mammographic appearance of calcifications as a predictor of intraductal carcinoma histologic subtype

We reviewed 109 consecutive cases of intraductal carcinoma to evaluate the association between histologic subtype (comedo = 35, non-comedo = 71, mixed = 3) and calcification type, as assessed by histology (amorphous vs. crystalline) or by mammography (coarsely granular, irregular shape, linear, branching vs. fine granular, irregular, or more or less regular oval or circular forms). Calcifications were microscopically or mammographically detected in 90.8% and 76.1% of cases, respectively, and a significant association was found between microscopic (amorphous) and mammographic (coarse granular, linear, branching) calcified types and histologic comedo subtypes (P <0.001). Nevertheless, accurate prediction of the histologic subtype on the basis of mammographic calcifications occurred only in 78.3% of cases with calcifications, and in 59.6% of all cases. Mammography is not a reliable method to predict DCIS histologic subtype at the present time. Correspondence to: S. Ciatto     

Mammographic and histologic correlations of microcalcifications

The majority of microcalcifications found on mammograms are associated with benign disease; however, some types accompany malignant disease. By correlating histologic with mammographic findings, the radiologist may gain an understanding of the morphologic characteristics and distribution of microcalcifications. We present radiologic and histologic images from a series of cases of nonpalpable, clustered microcalcifications. Such microcalcifications can be divided into two basic histologic groups: lobular and ductal. Although rounded, similarly shaped lobular calcifications can be differentiated mammographically from ductal calcifications with their irregular margins and varying size and shape, both types can be associated with benign and malignant processes. Biopsy is usually needed to confirm the diagnosis when clustered microcalcifications are found at mammography.     

Computer-aided diagnosis scheme for identifying histological classification of clustered microcalcifications by use of follow-up magnification mammograms

RATIONALE AND OBJECTIVES: Our purpose in this study was to investigate the usefulness of follow-up magnification mammograms (i.e., both current and previous magnification mammograms) in a computer-aided diagnosis (CAD) scheme for identifying the histological classification of clustered microcalcifications. MATERIALS AND METHODS: Our database consisted of current and previous magnification mammograms obtained from 93 patients before and after 3-month follow-up: 11 invasive carcinomas, 19 noninvasive carcinomas of the comedo type, 25 noninvasive carcinomas of the noncomedo type, 23 mastopathies, and 15 fibroadenomas. In our CAD scheme, we extracted five objective features of clustered microcalcifications from each of the current and previous magnification mammograms by taking into account image features that experienced radiologists commonly use to identify histological classifications. These features were then merged by a modified Bayes discriminant function for distinguishing among five histological classifications. For the input of the modified Bayes discriminant function, we used five objective features obtained from the previous magnification mammogram (previous features), five objective features obtained from the current magnification mammogram (current features), and the set of the five previous features and the five current features. RESULTS: The classification accuracies with the five current features were higher than those with the five previous features. These classification accuracies were improved substantially by using the set of the five previous features and the five current features. For the set of the five previous features and the five current features, the classification accuracies of our CAD scheme were 81.8% (9 of 11) for invasive carcinoma, 84.2% (16 of 19) for noninvasive carcinoma of the comedo type, 76.0% (19 of 25) for noninvasive carcinoma of the noncomedo type, 73.9% (17 of 23) for mastopathy, and 86.8% (13 of 15) for fibroadenoma. CONCLUSION: Our CAD scheme with use of follow-up magnification mammograms improved classification performance for mammographic clustered microcalcifications.     

Clinically occult ductal carcinoma in situ detected with mammography: analysis of 100 cases with radiologic-pathologic correlation

One hundred consecutive cases of clinically occult ductal carcinoma in situ (DCIS) detected with mammography were retrospectively analyzed to determine the spectrum of mammographic appearances and to study pathologic correlations. Seventy-two percent of the lesions appeared as microcalcifications, 10% as soft-tissue abnormalities, and 12% as a combination of the two. Six percent of lesions were found incidentally in the biopsy specimen. On the basis of mammographic measurements, 22% of the lesions were 5 mm or smaller, and 75% were 20 mm or smaller. Thirty-five percent of the microcalcification clusters were categorized as predominantly casts (linear), 52% as granular, and 13% as granular with several casts. Related pathologic features included the location of the tumor within the ductal system, pattern of growth (histologic subtype), amount and distribution of calcium formation, and presence or absence of reactive changes. Women aged 49 years or less with DCIS were more likely to have microcalcifications and less likely to have a soft-tissue mass than women aged 50 years or more (P = .04). The authors conclude that there is a wide spectrum of mammographic appearances of clinically occult DCIS.     

Mammographic features of ductal carcinoma in situ (DCIS) present on previous mammography.

AIM: To review previous mammograms of women found later to have DCIS and identify features which may have been missed or misinterpreted as benign. METHODS: The previous mammograms of 50 women who developed DCIS were analysed. The mammographic features at diagnosis and on the prior mammograms were compared. RESULTS: 11 (22%) of the previous mammograms were in retrospect abnormal; 5 (45%) of these had previously been assessed for the abnormality. All showed microcalcification. The following features were commoner at diagnosis than on previous films; rod shaped calcification (64 vs. 27%, P = 0.03) and a ductal distribution of calcification (76 vs. 45%, P = 0.05). Predominantly punctate calcification (64 vs. 12%, P = 0.001) and less than 10 calcifications in the cluster (54 vs. 24%, P = 0.05) were more common on the previous films. No difference was found in the frequency of granular calcification, branching calcification, irregularity in density, size or shape of calcification between the two groups. CONCLUSION: Features of DCIS missed on previous mammography include small cluster size, less than 10 calcifications in the cluster, the absence of rod shaped calcifications, the absence of a ductal distribution and the presence of predominantly punctate calcification. Features frequently seen both at diagnosis and on previous films which might have allowed earlier diagnosis were granular calcifications which vary in size, density and shape in an irregularly shaped cluster. Focal clustered calcification deserves aggressive investigation.     

Sonographic differentiation of invasive and intraductal carcinomas of the breast

The purpose of this study is to evaluate the diagnostic ability of ultrasound and define the sonographic features of symptomatic intraductal and invasive breast carcinoma. To achieve this the ultrasound features of 488 invasive carcinomas and 65 non-screening detected intraductal carcinomas were compared retrospectively. The features included size, AP/W (anteroposterior diameter/width) ratio, shape, margin, internal echogenicity, internal echotexture, posterior acoustic transmission, bilateral edge shadowing sign and calcifications. The sensitivity and specificity of the detection of calcifications by ultrasound in comparison with mammography were also studied. The accuracy of ultrasound diagnosis is 92.0% for invasive carcinoma of breast and 84.8% for intraductal carcinoma. Differentiation of ultrasound features of intraductal and invasive carcinoma can be based on the internal hypoechogenicity, loss of bilateral edge shadowing, posterior acoustic transmission, irregular shape and non-uniform internal echotexture with odds ratio of 0.3, 0.3, 0.4, 0.5 and 0.5, respectively. Internal echogenicity was the only significant differentiating factor on multiple logistic regression analysis. Non-comedo type ductal carcinoma in situ can be differentiated from comedo type by irregular shape with odds ratio of 0.3. The sensitivity, specificity and accuracy rate for the detection of calcifications in invasive carcinomas by ultrasound were 65.1%, 61.9% and 63.2%; in comedo type intraductal carcinoma 62.5%, 66.7% and 63.6%, and in non-comedo type intraductal carcinoma 30.0%, 86.7% and 64.0%, respectively. The ultrasound appearance of non-screening detected intraductal carcinoma is relatively isoechoic in comparison with invasive carcinoma. More than 60% of microcalcifications in comedo type intraductal carcinoma can be accurately demonstrated by ultrasound. However, the role of ultrasound in detecting symptomatic intraductal carcinoma warrants further study.     

Image-guided core breast biopsy of ductal carcinoma in situ presenting as a non-calcified abnormality

Objective: Ductal carcinoma in situ (DCIS) typically presents as calcifications which are detected mammographically. Our aim was to evaluate the less common presentations of ductal carcinoma in situ diagnosed by image-guided core biopsy and correlate with histopathologic diagnoses. Methods and Material: Imaging and histopathologic findings were retrospectively reviewed in 11 patients with ductal carcinoma in situ diagnosed at core biopsy that presented as noncalcified radiographic abnormalities. Results: Mammography showed non-calcified, circumscribed nodules, ill-defined nodules and architectural distortion. In two patients, no mammographic abnormality was detected. Sonography showed circumscribed, round or oval, solid masses; irregular, heterogeneous masses; and a tubular structure. Histopathologic diagnoses included multiple architectural subtypes and ranged from low to high nuclear grade. Conclusion: Although image-guided core biopsy diagnosis of ductal carcinoma is typically made when sampling calcifications, DCIS can be diagnosed following biopsy of non-calcified masses or distortion. There is no correlation between histopathologic subtype and radiologic appearance.     

Underestimation of breast cancer with II-gauge vacuum suction biopsy

OBJECTIVE. The purpose of this study was to determine the mammographic and histologic features of cancerous lesions underestimated using 11-gauge vacuum suction biopsy. MATERIALS AND METHODS. Retrospective review of 11-gauge vacuum suction biopsy was performed to identify lesions diagnosed as atypical ductal hyperplasia or carcinoma. The histology of the core and surgical specimens was compared. Of 158 cases of cancer, underestimation occurred in 15 (9.5%). The mammographic and histologic features were assessed. RESULTS. Of 15 underestimated cases, six were atypical ductal hyperplasia that proved to be cancer (5 ductal carcinoma in situ and 1 invasive) and nine were ductal carcinoma in situ that proved to have invasion. The underestimation rate for calcifications was 16.3% (14/86) and for masses was 1.6% (1/64) (p = 0.007). Most (5/6) underestimated atypical ductal hyperplasia cases were reported as "markedly atypical," and four of nine underestimated ductal carcinoma in situ cases were reported as "possible invasion." No significant difference was seen in the number of core specimens obtained or the sizes of the lesions for underestimated cases versus accurately diagnosed cases. The percentage of calcifications retrieved was significantly different (p = 0.017). No underestimations were found among cases in which the entire mammographic lesion was removed at vacuum suction biopsy. CONCLUSION. The cancer underestimation rate with vacuum suction biopsy was 9.5%. The underestimation rate for calcifications (16.3%) was significantly higher than that for masses (1.6%) (p = 0.007). The percentage of the lesion removed was an important factor in reducing underestimation, as reflected by the percentage of calcifications retrieved and the instances of complete resolution of the lesion seen on mammography.     

Ductal carcinoma in situ diagnosed with stereotactic core needle biopsy: can invasion be predicted?

PURPOSE: To determine whether mammographic or histologic features can be used to predict which cases diagnosed as ductal carcinoma in situ (DCIS) without invasion by means of stereotactic core needle biopsy (SCNB) will have invasive disease at surgery. MATERIALS AND METHODS: From July 1992 to March 1999, DCIS without invasion was diagnosed by means of SCNB in 59 patients. Seventeen (29%) were found to have invasive disease after surgery. The underestimation rate for SCNB was compared with that obtained by means of open surgical biopsy. Mammographic and histologic features of cases with and those without invasion were compared. RESULTS: All patients had calcifications on mammograms. There was no significant difference (P: =.26) between the underestimation rate for SCNB with the 11-gauge vacuum-assisted device and that for open surgical biopsy. No statistically significant differences between cases with and those without invasion were seen in patient age, mean number of core specimens, level of suspicion, size of lesion, distribution and morphology of the calcifications, presence of an associated mass or density, subtype of DCIS, nuclear grade, or presence of necrosis or desmoplasia. CONCLUSION: Mammographic and histologic features cannot be used reliably to predict cases that are underestimated with SCNB. However, SCNB with the 11-gauge vacuum-assisted device was as reliable as open surgical biopsy for diagnosing DCIS without invasion.     

Breast US in patients who had microcalcifications with low concern of malignancy on screening mammography

PURPOSE: To review ultrasound (US) findings in patients who have suspicious microcalcifications with low concern of malignancy (BI-RADS category 4A) on screening mammography and to evaluate helpful findings in differentiating benign and malignant lesions. MATERIALS AND METHODS: Between August 2005 and July 2006, 192 patients showed microcalcifications only, without mass or associated density, on screening mammography. Among them, we selected 82 patients who had microcalcifications with low concern of malignancy (category 4A) that were pathologically confirmed by surgical excision after wire localization (n=23) or biopsy (n=59). Breast US was performed in 37/82 cases and we analyzed the US findings for the calcification areas in these patients, evaluating the findings with benign or malignant pathological results. We correlated US findings with mammographic calcifications using mammography-guided 2D-localization for the calcifications before US examination. RESULTS: There were 12 malignant lesions (32.4%) including 3 invasive ductal carcinomas (IDC), one microinvasive ductal carcinoma (MIDC), 8 ductal carcinoma in situ (DCIS) and 25 benign lesions (67.6%) including 2 atypical ductal hyperplasias (ADH). IDC showed calcifications within heterogeneous hypoechoic parenchyma or calcifications within complex hypoechoic masses of taller-than-wide shape on US. One MIDC showed calcifications within heterogeneous hypoechoic parenchyma and six DCIS showed negative findings, or calcifications with a small nodule, or only calcifications on US. The most common positive US finding in benign lesions was cysts with calcifications. In 24/37 cases (64.8%) with negative US findings, 18 (75%) were benign lesions and 6 (25%) were DCIS. CONCLUSION: In patients with category 4A microcalcifications without associated findings on screening mammography, negative US findings had a high rate of benign results (18/24, 75%). Visible calcifications within heterogeneous hypoechoic parenchyma or mass on US increased the probability of malignancy.     

Non-palpable breast lesions and core needle biopsy with Mammotome 11G: is surgery required in patients with atypical ductal hyperplasia?

Atypical ductal hyperplasia (ADH) of the breast is a difficult histologic diagnosis. It is usually found, but not always, on clusters of microcalcifications. The subsequent risk of breast carcinoma is 4 to 5 times more important and the carcinoma can arise in the same breast or in the contralateral breast. Diagnosis can be establish on core needle biopsy with Mammotome 11G. The risk of under-estimation (ductal carcinoma in situ or invasive carcinoma) is about 20%. This risk is drastically decreased if the target (the calcifications) is completely removed by the Mammotome. This study includes 62 cases of ADH found on 633 calcifications biopsied by Mammotome 11G. In 31 cases, surgery was performed and ADH was confirmed in 25 cases (6 cases was under-estimated). In the other 31 cases, all calcifications were removed, there was no other risk factor and follow-up was suggested. Like after surgery, yearly bilateral mammography during about 20 years is recommended. In this last group, there was no false-negative result, median follow-up: 35,5 months (22-62).     

Mammography of ductal carcinoma in situ of the breast: review of 909 cases with radiographic-pathologic correlations

We retrospectively analysed mammographies of 909 ductal carcinoma in situ (DCIS) (1980-1999) and compared our results to those of literature. Microcalcifications were present in 75% of the cases, and soft-tissue abnormalities in 27% cases with association with calcifications in 14% of cases. Palpable masses were found in 12% of the cases and nipple discharge was present in 12% of the cases. The radiographic-pathologic correlation allowed to suspect the DCIS "aggressiveness" on radiologic signs. Granular, linear, branching and/or galactophoric topography of the microcalcifications were correlated with necrosis, grade 3, comedocarcinoma type. A number of microcalcifications higher than 20 was correlated with necrosis and grade 3. Mammographic size was correlated to histologic size. Masses were correlated with grade 1. A diagnosis strategy can be proposed with a multidisciplinar approach.     

Mammographic analysis of calcifications.

Because mammographically detected calcifications are frequently the only sign of breast cancer, the breast radiography equipment, screen-film imaging package, and film processing should be optimized to detect such calcifications. For this purpose, dedicated units with molybdenum targets, microfocal spot magnification capability, reciprocating grids, and high output x-ray tubes are required. With the greater use of state-of-the-art mammography, intraductal carcinoma, or DCIS, manifested only by calcifications is being detected more frequently than ever. DCIS can be of the comedo, cribriform, or micropapillary types. Comedocarcinoma, characterized by linear and branching (casting) calcifications, is the most aggressive type, and it has the highest rate of recurrence after breast-conserving surgery. Cribriform and micropapillary calcifications are characteristically punctate and vary in size and shape. In addition to histologic type, the recurrence of DCIS is related to its extent at detection and whether adequate tissue was removed at the time of breast-conserving surgery. Biopsies for suspicious calcifications should be followed immediately by specimen radiography to verify their removal. If breast-conserving surgery is elected for DCIS, the resected segment of tissue should be examined with pathologic techniques designed to determine whether the margins are clear of tumor. For DCIS and invasive cancers with extensive intraductal component, microfocus magnification mammography over the surgical site is recommended prior to radiotherapy to identify any residual tumor calcifications. Although state-of-the-art mammography is very sensitive in the detection of calcifications, it is low in specificity, thus resulting in a large number of false-positive mammograms and a relatively low true-positive biopsy rate. While some benign calcifications cannot be distinguished from those of malignancy, the number of biopsies for benign conditions can be decreased by careful analysis of the mammograms in a search for features indicating benignity.     

Nonpalpable breast cancer: mammographic appearance as predictor of histologic type.

PURPOSE: To investigate the association between mammographic appearance and histologic diagnosis of nonpalpable breast cancers. MATERIALS AND METHODS: Mammographic characteristics of 317 consecutive clinically nonpalpable breast cancers in patients treated with breast-conserving surgery were reviewed. Malignant lesions were categorized as spiculated masses, other lesions, calcifications, and combined findings. Calcifications were characterized as amorphous, pleomorphic, or fine linear and branching. Logistic regression was used for the evaluation. Odds ratios (ORs) represent the magnitude of the association between a histologic diagnosis and a mammographic finding. RESULTS: Spiculated mass without calcifications (n = 150) and calcifications alone (n = 79) accounted for three of four cancers. A spiculated mass without calcifications was strongly associated with invasive cancers (OR = 12). Calcifications alone were strongly associated with ductal carcinoma in situ (DCIS) (OR = 19). In a decreasing order, the following invasive cancers were each associated with spiculated lesions without calcifications: ductal carcinoma grade 1 (OR = 28), ductal carcinoma grade 2 (OR = 17), lobular carcinoma (OR = 11), and ductal carcinoma grade 3 (OR = 4.6). Fine linear and branching calcifications alone were associated with not only DCIS nuclear grades 3 (OR = 17) and 2 (OR = 9.7) but also with invasive ductal carcinoma grade 3 (OR = 13). CONCLUSION: Mammographic appearance can be a predictor of histologic diagnosis in three of four nonpalpable breast cancers.     

Stereotactic vacuum biopsy of calcifications with a handheld portable biopsy system: a validation study

To prospectively evaluate a compact portable 10-gauge handheld battery-operated biopsy system for stereotactic biopsy of microcalcifications. The ethics committee of the hospital approved this prospective multicentric study, and informed consent was obtained. Biopsy under stereotactic guidance was performed in 215 patients for 219 lesions consisting of microcalcifications without mass. The feasibility and the tolerance of the procedure were evaluated. The mean weight of the specimen was calculated. In patients with surgical diagnoses, the underestimation rate in biopsy diagnoses of atypical ductal hyperplasia and ductal carcinoma in situ were evaluated. The sampled specimens were separated according to the presence of calcifications on magnified specimen radiographs and to the probe the rotation number in order to evaluate the contribution of each rotation and the contribution of the specimen with and without calcifications on the radiographs. The macrobiopsy was feasible in 98.5% of the patients and was well tolerated in 82% of patients. It identified 4.6% invasive carcinomas, 18.5% ductal carcinomas in situ, 14.8% atypical ductal hyperplasias, 22.2% benign proliferative mastopathies and 39.8% benign non-proliferative mastopathies. The underestimation rate was 26.6% when an atypical ductal hyperplasia was diagnosed at biopsy, and 7.7% when a ductal carcinoma in situ was diagnosed. In the 77 patients with surgical correlation, the accurate diagnosis was obtained in specimens sampled during the first, second, and third in 69%, 9%, and 4% of the biopsies, respectively, and the analysis of specimens without microcalcification had an added value in 8% of patients. The compact portable battery-operated biopsy system can be used successfully for stereotactic biopsy of microcalcifications and constitutes a valid alternative to current systems.     

Mucinous breast carcinoma showing as a cluster of suspicious microcalcifications on mammography

We report a case of mucinous breast carcinoma whose mammographic features consisted of a suspicious cluster of microcalcifications as the unique sign of malignancy. The lesion was non-palpable and measured approximately 2 cm at the greatest diameter. The microcalcifications showed several morphologies: round, pleomorphic, and fine shapes were identified. The total number of microcalcifications was > 30 and the number per square centimeter varied from 10 to 20. The histological calcifications showed good correlation with the mammographic ones and were localized predominantly at the periphery of the tumor inside ducts with ductal carcinoma in situ or in the acellular mucin. Two types were observed: psammomatous and gross-irregular calcifications. To our knowledge, only one case with similar findings has been reported previously. Received 10 November 1997; Revision received 3 April 1998; Accepted 2 June 1998     

Aspects in mammographic screening. Detection,prediction, recurrence and prognosis

Screening mammograms comprising of 32 first round, 10 interval and 32 second round detected cancers and 46 normal were examined by an expert screener, a screening radiologist, a clinical radiologist and a computer-assisted diagnosis (CAD) system. The expert screener, screening radiologist, clinical radiologist and the CAD detected 44, 41, 34 and 37 cancers, respectively, while their respective specificities were 80%, 83%, 100% and 22%. Later, with CAD prompting, the screening and the clinical radiologist detected 1 and 3 additional cancers each with unchanged specificities. Screening mammograms comprising 35 first round, 12 interval and 14 second round detected cancers and 89 normal findings were examined without and with previous mammograms by experienced screeners. Without previous mammograms, the screeners detected 40.3 cancers with a specificity of 87%. With previous mammograms, 37.7 cancers were detected with a 96% specificity. The decrease in sensitivity was not significant but the screeners showed significant increase in specificity. Local recurrences in 303 nonpalpable breast cancers with preoperative localizations and breast conservation therapy were evaluated for needle-caused implant metastasis. A total of 214 percutaneous biopsies were performed. There were 33 local recurrences. Needle-caused seeding or implantation as based on the location of the recurrence in comparison to the needle path in the mammograms was suspected in 3/44 (7%) invasive cancers without radiotherapy. The mammographic characteristics of 317 nonpalpable breast cancers were categorized. Logistic regression showed that the risk ratios for a spiculated mass without calcifications and calcifications alone were 12 and 19 for invasive cancer and ductal cancer in situ (DCIS), respectively. Invasive ductal grade 1, ductal grade 2, lobular and ductal grade 3, had a risk ratio (RR) of 28, 17, 11 and 4.6, respectively, for a spiculated mass without calcifications. DCIS nuclear grade 3 and invasive ductal grade 3 had an RR of 17 and 9.7, respectively, for sole casting calcifications. The eight-year survival of 96 1-9-mm invasive breast cancers were investigated in relation to their mammographic appearance, node status and histologic grade. After a median follow-up of 7 years, 6/96 died from breast cancer: 3/14 had calcifications alone, 2/56 had spiculated masses, 1/12 had rounded mass, 5/78 were node-negative and 1/4 was node-positive. The survival rate was 93%: 77% for the calcifications alone, 95% for spiculated masses, 91% for rounded masses, 92% for node-negative and 75% for node-positive. Calcifications alone and node positivity, each, carried a significantly higher risk of death.     

Stereotactic breast biopsy: en bloc excision of microcalcifications with a large-bore cannula device.

OBJECTIVE: Breast calcifications pose a significant diagnostic and procedural dilemma. We evaluated en bloc stereotactic excision of indeterminate and suggestive microcalcifications for histologic diagnosis using a large-bore cannula biopsy device. MATERIALS AND METHODS: We retrospectively reviewed 61 groups of microcalcifications removed with a large-bore cannula biopsy device from 59 patients (age range, 35-72 years old). The cannula diameter was 20 mm in 47 cases, 15 mm in nine cases, and 10 mm in five cases. The median lesion diameter was 6.6 mm (range, 4-17 mm). The procedure was performed by radiologists in an outpatient setting, with patients undergoing local anesthesia. All patients with a diagnosis of malignancy underwent surgery. RESULTS: In all instances, microcalcifications were removed in a single pass, in a single intact tissue specimen, through a maximum skin incision of 2 cm (0.8 inch). Twenty-five malignancies, 34 benign lesions, and two cases of lobular carcinoma in situ were identified. Sixteen malignancies were noninvasive and nine were invasive. No residual tumor was found at surgery in six of the 18 cases with involved margins and in five of the seven cases with uninvolved margins. One case of lobular carcinoma in situ with involvement of the margins additionally showed ductal carcinoma in situ at surgery. CONCLUSION: Mammographically identified microcalcifications are excised en bloc with the large-bore cannula biopsy device, providing a stereotactically localized tissue sample that is comparable with that obtained with open surgical biopsy and allows evaluation of the margins. This surgical radiologic procedure may represent a valid alternative, in selected patients, to conventional surgical biopsy after radiologic localization.     

Screening mammography-detected cancers: sensitivity of a computer-aided detection system applied to full-field digital mammograms

PURPOSE: To retrospectively evaluate the sensitivity of the performance of a computer-aided detection (CAD) system applied to full-field digital mammograms for detection of breast cancers in a screening group, with histologic findings as the reference standard. MATERIALS AND METHODS: This study had institutional review board approval, and patient informed consent was waived. A commercially available CAD system was applied to the digital mammograms of 103 women (mean age, 51 years; range, 35-69 years) with 103 breast cancers detected with screening. Sensitivity values of the CAD system according to mammographic appearance, breast composition, and histologic findings were analyzed. Normal mammograms from 100 women (mean age, 54 years; age range, 35-75 years) with no mammographic and clinical abnormality during 2-year follow-up were used to determine false-positive CAD system marks. Differences between the cancer detection rates in fatty and dense breasts for the CAD system were compared by using the chi(2) test. RESULTS: The CAD system correctly marked 99 (96.1%) of 103 breast cancers. The CAD system marked all 44 breast cancers that manifested as microcalcifications only, all 23 breast cancers that manifested as a mass with microcalcifications, and 32 (89%) of 36 lesions that appeared as a mass only. The sensitivity of the CAD system in the fatty breast group was 95% (59 of 62) and in the dense breast group was 98% (40 of 41) (P = .537). The CAD system correctly marked all 31 lesions of ductal carcinoma in situ (DCIS), all 22 lesions of invasive ductal carcinoma with DCIS, the single invasive lobular carcinoma lesion, and 45 (92%) of 49 lesions of invasive ductal carcinoma. On normal mammograms, the mean number of false-positive marks per patient was 1.80 (range, 0-10 marks; median, 1 mark). CONCLUSION: The CAD system can correctly mark most (96.1%) asymptomatic breast cancers detected with digital mammographic screening, with acceptable false-positive marks (1.80 per patient).