Mammographic bi-dimensional product: a powerful predictor of successful excision of ductal carcinoma in situ

BACKGROUND: The aim of this analysis was to ascertain whether uni-dimensional measurement of mammographic microcalcification, the product of bi-dimensional measurement, calcification morphology, and pathological grade are helpful in predicting successful single therapeutic wide local excision (WLE) of ductal carcinoma in situ (DCIS). METHODS: The study group comprised 505 patients whose mammograms showed the DCIS as calcification, and in whom a non-operative diagnosis had been obtained and WLE attempted. The extents of mammographic calcifications was measured in two planes at 90 degrees on the oblique view, the appearances classified as comedo, granular, or punctate. DCIS was graded using cyto-nuclear characteristics. RESULTS: Three hundred and forty-two patients had a successful first WLE and 163 patients had further surgery. A uni-dimensional measurement of <35 mm and a bi-dimensional product of <800 mm(2) were associated with successful excision (69 versus 54%, p=0.02 and 70 versus 27%, p=0.0001, respectively). Mammographic calcification morphology and histological grade did not influence the likelihood of a successful first WLE. For high-grade DCIS, the upper limit of the bi-dimensional product associated with successful WLE was 800 mm(2) (69 versus 24%, p=0.0003). In contrast, for non-high-grade DCIS, the cut-off was 400 mm(2) (73 versus 33%, p=0.01). Analyses based on mammographic calcification morphology gave similar findings. CONCLUSION: The mammographic bi-dimensional product is a powerful predictor of successful WLE of DCIS when combined with histological grade and/or calcification morphology.     

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.     

临床不能扪及的乳腺导管原位癌及其早期浸润的X线征象分析

目的:分析临床不能扪及的乳腺导管原位癌(DCIS)及其早期浸润的X线征象。方法:经手术、病理证实的乳腺导管原位癌16例和原位癌伴早期浸润9例,观察其X线表现,并与病理对照。结果:25例X线表现均为钙化,其中按钙化形态分导管原位癌以碎石样钙化为主(6/16,37.5%),原位癌伴早期浸润以杆状钙化为主(5/9,55.56%);按钙化分布分,导管原位癌以成簇钙化为主(11/16,68.75%),原位癌伴早期浸润以成簇、段样为主(两者均为4/9,44.44%)。结论:DCIS及其早期浸润的X线表现有一定特征,通过乳腺X线检查,可提高DCIS及其早期浸润的检出率。     

Predicting invasion in mammographically detected microcalcification

AIM: To identify pre-operative factors which predict presence of invasive disease within mammographically detected malignant microcalcification. MATERIALS AND METHODS: A retrospective analysis was undertaken of 116 serial stereotactic core needle biopsies (SCNBs) performed on malignant mammographic calcification. Final surgical pathology was correlated with pre-operative features (clinical, radiological and core histology) in an attempt to predict the presence of an invasive component. RESULTS: Thirty-eight clusters contained invasive carcinoma. The sensitivity of SCNB for invasion was 55%. Clinical features, calcium morphology and cluster size were not shown to be predictive of invasive disease. Ductal carcinoma in situ (DCIS) of high grade on core histology and increasing number of calcifications were predictive of increased risk of invasion (high grade core biopsy DCIS and > 40 calcifications 48% invasive at surgical histology; high grade core biopsy DCIS and < 40 calcifications 15% invasive; non-high grade core biopsy DCIS 0% invasive). CONCLUSIONS: Identification of those clusters diagnosed as DCIS by percutaneous biopsy which are likely to harbour an invasive component is possible. It would seem reasonable to consider staging the axilla at therapeutic surgery in these patients.     

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.     

Ductal carcinoma in situ of the breast: correlation between mammographic calcification and tumor subtype.

OBJECTIVE. Histologic subtypes of ductal carcinoma in situ of the breast have been correlated with disease progression after local excision only. This study was undertaken to determine how the predominant type of calcification seen on mammography correlates with the predominant histologic tumor subtype, knowledge that could aid in the development of clinical criteria for selecting patients for appropriate local treatment. MATERIALS AND METHODS. A prospective double-blind study was performed to correlate the mammographic and histologic findings in 66 consecutive cases of ductal carcinoma in situ, or ductal carcinoma in situ associated with small invasive foci (n = 11), in which microcalcifications seen on mammograms were found in the ductal carcinoma during histologic evaluation of excisional biopsy specimens. Microcalcifications were categorized as predominantly linear or granular and were correlated with the predominant histologic subtype of ductal carcinoma in situ in the tissue containing the calcifications seen on mammograms. RESULTS. Predominantly linear calcifications were present in 47% (18/38) of ductal comedocarcinomas in situ compared with 18% (5/28) of cribriform, solid, or papillary subtypes (p = .01). Predominantly granular calcifications were present in 53% (20/38) of comedocarcinomas compared with 82% (23/28) of the noncomedo types (p = .01). In 94% (16/17) of cribriform ductal carcinomas in situ, granular microcalcifications were seen on mammograms. Seventy-eight percent (18/23) of linear calcifications in ductal carcinoma in situ were associated with the comedo subtype, whereas 53% (23/43) of the granular calcifications were associated with noncomedo subtypes. CONCLUSION. We conclude that the comedo subtype of ductal carcinoma in situ is more likely to be accompanied by linear calcifications than are the noncomedo subtypes, and noncomedo ductal carcinoma in situ is more likely to be associated with granular calcifications than is the comedo subtype when microcalcifications are seen on mammograms. However, there is considerable overlap, and the predominant histologic subtype cannot be predicted on the basis of the microcalcification type with a high degree of accuracy.     

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.     

早期乳腺癌的CR表现及病理基础

目的评价早期乳腺癌的CR表现及其病理基础。方法回顾性分析经病理证实的43例早期乳腺癌的CR片,包括导管原位癌及导管原位癌伴微浸润30例、浸润性导管癌12例和浸润性小叶癌1例,观察早期乳腺癌的CR表现,并与病理对照。结果(1)43例早期乳腺癌中,CR表现钙化21例(49%),结节15例(35%),非对称性局限性密度增高影伴结构紊乱7例(16%)。(2)乳腺数字化图像可以显示早期乳腺癌病变的细微结构。结论乳腺CR成像对早期乳腺癌的诊断具有重要意义。     

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     

钼靶结合MRI对乳腺导管原位癌诊断价值的探讨

目的:分析乳腺导管原位癌的X线及MRI表现,评价钼靶结合MRI对DCIS术前诊断价值。方法:回顾性分析经手术病理证实的乳腺DCIS病例13例,所有病例均于术前行动态增强MRI和钼靶X线检查,同时行免疫组化标记。结果:①将病灶的X线表现分成恶性钙化、中间性钙化和非钙化3组,PR与C-erbB-2在3组中的分布有统计性意义(P<0.05);②13例病灶中11例MR表现为非肿块样强化,以BI-RADS分级中的4、5级为MR和X线检查的阳性指标,其正确诊断率差异无统计学意义(P>0.05)。结论:DCIS的钼靶X线表现可以作为乳腺DCIS的预后因子,乳腺MRI对导管原位癌及导管原位癌伴微浸润有特征性表现,钼靶X线和MR检查相结合能提高早期导管原位癌的检出率及正确诊断率。     

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.     

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.     

Sonographic appearance of mucinous carcinoma of the breast

OBJECTIVE: The aim of this study was to evaluate the sonographic and mammographic features of mucinous carcinoma and to correlate the imaging features with two histologic classifications. MATERIALS AND METHODS: Two radiologists analyzed the mammographic and sonographic features of 33 mucinous carcinomas. Mammographic features according to the Breast Imaging Reporting and Data System (BI-RADS) and sonographic features were recorded and analyzed. The imaging features of the mass were correlated with the nuclear grade and mucin content of these 33 mucinous carcinomas. The incidence of axillary lymph nodes metastasis in different histologic grades and their detection by imaging were also assessed. RESULTS: As many as 21.2% (7/33) of mucinous carcinomas could not be detected mammographically. When they were detected mammographically, more than 92% of the tumors presented as a mass, either oval or lobular. Microlobulations were present in 38.5% of these lesions. The margin of the lesion as seen on mammography can be used to predict the histologic grade. A circumscribed margin was associated with a favorable histologic grade (p = 0.01), whereas an indistinct margin was more commonly associated with the mixed type of lesion (p = 0.05). Sonographically, mixed cystic and solid components, distal enhancement, and microlobulated margins were commonly found in mucinous carcinomas, with an incidence of 37.5%, 43.8%, and 56.3%, respectively. Homogeneity on sonography was associated with the pure type of mucinous carcinoma and hence a better prognosis. Sonography showed a sensitivity of 50%, specificity of 89%, positive predictive value of 60%, negative predictive value of 84%, and accuracy of 79.2% in the detection of axillary lymph node metastasis. CONCLUSION: Both sonographic and mammographic assessments are important in the correct diagnosis of mucinous carcinoma, the prediction of histologic grade, and the prognosis of the tumors.     

乳腺黏液腺癌X线摄影表现与病理对照分析

目的探讨乳腺黏液腺癌X线摄影表现的病理学基础。方法回顾性分析30例乳腺黏液腺癌（单纯型19例,混合型11例）的X线摄影表现,并分析其病理特点。结果①乳腺黏液腺癌最常见的x线表现为肿块（25例）,伴或不伴钙化。少见征象为局部不对称性致密影伴钙化（5例）;②单纯型黏液腺癌X线表现多为边缘小分叶,混合型黏液腺癌X线摄影多表现为边缘浸润,两者差异有统计学意义;③肿块的形状、大小、密度情况在判断黏液腺癌的病理分型上无统计学意义。结论不同亚型的乳腺黏液腺癌的X线摄影表现不完全一致,单纯型黏液腺癌最常见的表现为边缘小分叶的肿块,较少伴钙化;混合型黏液腺癌最常见的表现为边缘浸润的肿块,多伴细小、多形性钙化。     

A comparison of 14 and 12 gauge needles for core biopsy of suspicious mammographic calcification

This study was carried out to compare the efficacy of 14 vs 12 G needles in stereotactic core biopsy of mammographic calcification. A consecutive series of 100 impalpable mammographic calcifications, without an associated mass and requiring stereotactic core biopsy were randomly allocated to either 14 G or 12 G needle sampling. All biopsies were performed using an upright stereotactic digital unit (Senovision GE) and a Bard automated biopsy gun. Core biopsy results were categorized as either normal, benign, atypical ductal hyperplasia, suspicious of ductal carcinoma in situ (DCIS), DCIS or invasive cancer. The radiographic calcification retrieval rates, complete and absolute sensitivity for malignancy of DCIS and DCIS with an invasive focus were obtained by comparison of core results with surgical histology. Radiographic calcification retrieval was achieved in 86% when using 14 G and 12 G needles. The absolute sensitivity and complete sensitivity for diagnosing DCIS were the same with 12 G and 14 G needles (72% versus 71% and 93% versus 94%, respectively). The use of 12 G needles does not appear to confer benefit over the use of 14 G needles in the diagnosis of mammographic calcification.     

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.     

US of ductal carcinoma in situ.

Little is known about the ultrasonographic (US) features of ductal carcinoma in situ (DCIS) of the breast because this entity usually manifests as pure mammographic calcifications and is rarely evaluated with US. US findings were recorded in 70 patients with DCIS and then analyzed and correlated with mammographic and histologic findings. A microlobulated mass with mild hypoechogenicity, ductal extension, and normal acoustic transmission was the most common US finding in DCIS. Spiculated margins, marked hypoechogenicity, a thick echogenic rim, and posterior acoustic shadowing at US often suggested the presence of invasion. US performed with a 10-13-MHz transducer and optimal technique can be used as a complement to mammography in detecting and evaluating DCIS of the breast, as it demonstrates breast lesions associated with malignant microcalcifications in most cases. The main benefit of identifying a US abnormality in women with mammographically detected DCIS is to allow the use of US to guide interventional procedures (eg, needle biopsy, needle localization). US may also be helpful in detecting DCIS without calcifications and in evaluating disease extent in women with dense breasts. Nevertheless, further research is needed to delineate the role of US in the evaluation of patients with DCIS.     

How significant is detection of ductal carcinoma in situ in a breast screening programme?

PURPOSE: To compare the histological grades of screen detected and non-screen detected ductal carcinoma in situ (DCIS) and to identify any differences that might support the contention that DCIS found by breast screening represents an over-diagnosis. The aim was also to establish whether any particular mammographic features of DCIS can be used to predict tumour grade reliably. MATERIALS AND METHODS: Biopsy proven cases of DCIS (n=153) were reviewed with respect to grade and subdivided into high, intermediate and low grades using the Van Nuys classification. A more aggressive subset of DCIS (microinvasive and interval cancers) were similarly analysed. Mammograms were reviewed with regard to abnormal features and distribution, and the appearances correlated with grade. RESULTS: Fifty-four percent (53/98) of screen detected and 62% (34/52) of non-screen detected DCIS were high grade. The rest were equally intermediate and low grade, with no statistical difference between the two groups. Eighty-four percent of the aggressive subset of tumours were high grade. Micro-calcification was present in 90% and in 10% there were soft tissue changes alone. Seventy-six percent of linear branching calcification was associated with high grade DCIS. Only 13% of high grade DCIS demonstrated punctate micro-calcification; however, 38% of cases of punctate micro-calfication were associated with high grade tumours and there was a great deal of overlap between the groups. CONCLUSION: Most cases of DCIS in both screen and non-screen detected groups were high grade. Only one in five was low grade. Analysis of the aggressive subgroup underlines the significance of high grade DCIS. Mammographic patterns are not always reliable in the prediction of tumour grade. The detection of DCIS in screening programmes is important and should not be regarded as over-diagnosis.     

Calcifications of lobular carcinoma in situ of the breast: radiologic-pathologic correlation

OBJECTIVE: Because lobular carcinoma in situ is thought to be an incidental finding at breast pathology, the finding of lobular carcinoma in situ at core biopsy poses a diagnostic dilemma of radiologic-pathologic concordance. The purpose of this article is to describe the radiologic-pathologic correlation of calcifications associated with lobular carcinoma in situ of the breast. MATERIALS AND METHODS: Between July 1999 and July 2000, seven excisional biopsies resulted in findings of lobular carcinoma in situ of mammographic calcifications. The radiographic features of the calcifications were characterized by the Breast Imaging Reporting and Data System lexicon, and pathologic features were reviewed. RESULTS: Two forms of lobular carcinoma in situ were associated with calcifications: the classic form with small, uniform cells, and the pleomorphic form with larger cells frequently associated with central necrosis. On mammography, all calcifications were clustered, punctate, high density, and smaller than or equal to 0.5 mm, although mammographically visible calcifications found in the pleomorphic type tended to be larger and more dense. Additionally, infiltrating lobular carcinoma was found after surgical excision in two (40%) of five patients with pleomorphic lobular carcinoma in situ. CONCLUSION: Calcifications can be associated with lobular carcinoma in situ and therefore concordant at stereotactic core biopsy. The classic form may be incidental and clinically innocuous. The pleomorphic form is morphologically similar to ductal carcinoma in situ and may have a greater tendency for invasion.     

Mammographic features predicting an extensive intraductal component in early-stage infiltrating ductal carcinoma.

Several studies have shown that the presence of an extensive intraductal component in patients with infiltrating ductal carcinoma is a major factor for predicting local recurrence after breast-conserving surgery and radiotherapy. A prospective study of 101 consecutive mammograms in patients with stage I or II infiltrating ductal carcinoma was performed to determine the predictive values of mammographic features in determining the presence or absence of an extensive intraductal component. Thirty-five (35%) of the lesions contained a pathologically verified extensive intraductal component. Sixty-five percent (22/34) of lesions showing mammographic evidence of calcifications with or without a mass were associated with an extensive intraductal component (p less than .001). Lesions with calcifications greater than 3 cm in extent were significantly (p less than .05) more likely to have an extensive intraductal component (9/10; 90%) than those with calcifications less than 3 cm in extent (13/24; 54%). Only 17% (8/46) of patients in whom mammograms showed only a mass or architectural distortion and 24% (5/21) of patients who had a mass palpable clinically or who had normal findings on mammograms had lesions with an extensive intraductal component. We conclude that infiltrating ductal carcinomas associated with calcifications on mammography, especially if the calcifications are extensive, are likely to be associated with an extensive intraductal component. Carcinomas without calcifications that show masses or architectural distortion on mammography, or carcinomas with palpable masses and normal findings on mammography, are unlikely to have an extensive intraductal component.