Centennial dissertation. Percutaneous imaging-guided core breast biopsy: state of the art at the millennium.
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Biopsy, Needle↗
Biomedical subjects
L Liberman
Publications and source records attributed to L Liberman.
Cost-effectiveness of stereotactic 11-gauge directional vacuum-assisted breast biopsy.
OBJECTIVE: The purpose of our study was to determine the frequency with which stereotactic 11-gauge directional vacuum-assisted breast biopsy obviated a surgical procedure and to calculate cost savings attributable to that biopsy method. MATERIALS AND METHODS: We retrospectively reviewed 200 consecutive solitary nonpalpable lesions on which stereotactic 11-gauge directional vacuum-assisted breast biopsy was performed. Cost savings were calculated using Medicare reimbursements. Mammograms, histologic findings, and medical records were reviewed. RESULTS: Stereotactic 11-gauge directional vacuum-assisted biopsy obviated a surgical procedure in 151 (76%) of 200 lesions, including 112 (73%) of 154 calcific lesions and 39 (85%) of 46 masses. Reasons for not obviating a surgical procedure in 49 lesions (25%) included recommendation for surgical biopsy in 35 lesions (18%), small carcinomas treated by excision in 10 lesions (5%), and histologic underestimation in four lesions (2%). Stereotactic 11-gauge directional vacuum-assisted biopsy decreased the cost of diagnosis by S264 per case, a 20% ($264/$1289) decrease in the cost of diagnosis compared with surgical biopsy. Of 200 lesions that had stereotactic 11-gauge directional vacuum-assisted biopsy, 106 (53%) would not have been amenable to 14-gauge automated core biopsy because of their small size, their superficial location, or inadequate breast thickness. CONCLUSION: Stereotactic 11-gauge directional vacuum-assisted breast biopsy obviated a surgical procedure in 76% of lesions, yielding a 20% decrease in cost of diagnosis compared with surgical biopsy. Although savings per case are modest, 11-gauge directional vacuum-assisted biopsy expands the spectrum of lesions amenable to stereotactic biopsy, increasing cost savings in the population.
Adult↗
Palpable breast masses: is there a role for percutaneous imaging-guided core biopsy?
OBJECTIVE: The purpose of this study was to evaluate percutaneous imaging-guided core biopsy in the assessment of selected palpable breast masses. MATERIALS AND METHODS: Of 1388 consecutive breast lesions that had percutaneous imaging-guided core biopsy, 155 (11%) were palpable. Palpable masses referred for percutaneous imaging-guided core biopsy included lesions that were small, deep, mobile, vaguely palpable, or multiple. Biopsy guidance was sonography in 140 lesions (90%) and stereotaxis in 15 (10%). Surgical correlation or minimum of 2 years follow-up is available in 115 palpable masses in 107 women. Medical records, imaging studies, and histologic findings were reviewed. RESULTS: Of 115 palpable breast masses, 98 (85%) were referred by surgeons to the radiology department for percutaneous imaging-guided core biopsy and 88 (77%) had percutaneous imaging-guided core biopsy on the day of initial evaluation at our institution. Percutaneous imaging-guided core biopsy spared additional diagnostic tissue sampling in 79 (74%) of 107 women, including 57 women with carcinoma and 22 women with benign findings. Percutaneous imaging-guided core biopsy did not spare additional tissue sampling in 28 women (26%), including 15 women in whom surgical biopsy was recommended on the basis of percutaneous biopsy findings and 13 women with benign (n = 7) or malignant (n = 6) percutaneous biopsy findings who chose to undergo diagnostic surgical biopsy. CONCLUSION: Percutaneous imaging-guided core biopsy is useful in the evaluation of palpable breast masses that are small, deep, mobile, vaguely palpable, or multiple. In this study, percutaneous imaging-guided core biopsy spared additional diagnostic tissue sampling in 74% women with palpable breast masses.
Adult↗
Metastatic lobular carcinoma of the breast: patterns of spread in the chest, abdomen, and pelvis on CT.
OBJECTIVE: We determined the pattern of spread of metastatic lobular carcinoma in the chest, abdomen, and pelvis on CT. MATERIALS AND METHODS: We identified 57 women (age range, 30-79 years; mean age, 57 years) with metastatic lobular carcinoma of the breast who underwent CT of the chest, abdomen, or pelvis between 1995 and 1998. Then two experienced oncology radiologists retrospectively reviewed 78 CT examinations of those patients to identify sites of metastatic disease and to identify complications caused by metastases. RESULTS: Metastases were identified in bone in 46 patients (81%), lymph nodes in 27 patients (47%), lung in 19 patients (33%), liver in 18 patients (32%), peritoneum in 17 patients (30%), colon in 15 patients (26%), pleura in 13 patients (23%), adnexa in 12 patients (21%), stomach in nine patients (16%), retroperitoneum in nine patients (16%), and small bowel in six patients (11%). Eighteen patients (32%) had gastrointestinal tract involvement that manifested as bowel wall thickening. Hydronephrosis was present in six patients (11%). CONCLUSION: Although lobular carcinoma metastasized to common metastatic sites of infiltrating ductal carcinoma, lobular carcinoma frequently metastasized to unusual sites, including the gastrointestinal tract, peritoneum, and adnexa. Gastrointestinal tract involvement was as frequent as liver involvement, appearing as bowel wall thickening on CT. Hydronephrosis was a complication of metastatic lobular carcinoma.
Abdominal Neoplasms↗
Long term follow-up of women with ductal carcinoma in situ treated with breast-conserving surgery: the effect of age.
BACKGROUND: Although in recent years there has been a dramatic increase in both the incidence of ductal carcinoma in situ (DCIS) and breast-conserving therapy for patients who have this disease, the optimal treatment for these patients remains controversial. Most data regarding outcomes have come from small, retrospective studies, with little data published from prospective, randomized studies. This study investigates the effects of age, postoperative breast irradiation, and other factors on local relapse free survival after breast-conserving surgery for women with DCIS in a large, single-institution series. METHODS: A review was performed of all patients with DCIS who underwent breast-conserving surgery at Memorial Sloan-Kettering Cancer Center from 1978 through 1990. Of the 171 cases identified, data on follow-up and radiation therapy were available for 157. All available pathology slides (132 of 157) were rereviewed to determine histologic subtype, nuclear grade, presence of necrosis, and microscopic tumor size. Sixty-five patients (41%) received postoperative radiation therapy; selection criteria evolved over the time period. The median follow-up was 74 months. RESULTS: Factors that were significantly (P< or =0.05) associated with a lower recurrence rate were older age, noncomedo subtype, lower nuclear grade, negative margins, and postoperative radiation therapy. The 6-year actuarial recurrence rate was 9.6% for patients who received postoperative radiation therapy and 20.7% for patients who had excision only (P = 0.05). Comparison of patients of ages > or =70, 40-69, and <40 years revealed a significantly lower risk of recurrence with increasing age. Actuarial 6-year local relapse rates were 10.8%, 14.0%, and 47.2%, respectively (P = 0.047). A benefit from radiation therapy was suggested for each age group. There was no statistically significant correlation between age group and any histologic factor examined. In multivariate analysis, only margin status was statistically significant (P = 0.05). CONCLUSIONS: In addition to margin status, pathologic factors, and the use of radiation therapy, age is another factor that should be considered in assessing the risk of local recurrence after breast-conserving surgery for patients with DCIS.
Adult↗
Sentinel lymph node biopsy after percutaneous diagnosis of nonpalpable breast cancer.
PURPOSE: To determine the technical success rate of sentinel lymph node biopsy in women with nonpalpable infiltrating breast cancer diagnosed by using percutaneous core biopsy and to determine the frequency with which sentinel lymph node biopsy obviated axillary dissection. MATERIALS AND METHODS: Retrospective review revealed 33 women who underwent sentinel node biopsy after percutaneous core biopsy diagnosis of nonpalpable infiltrating breast cancer. Sentinel nodes were identified with radioisotope and blue dye; the procedure was technically successful if sentinel nodes were found at surgery. All sentinel nodes were excised. Axillary dissection was performed if tumor was present in sentinel nodes. RESULTS: Sentinel nodes were found at surgery in 30 women (91%). Sentinel nodes were identified with both radioisotope and blue dye in 22 (73%) of these women, with only radioisotope in six (20%), and with only blue dye in two (7%). Sentinel nodes were found in 12 (80%) of 15 women in the first half of the study versus all 18 (100%) women in the second half (P = .08). Sentinel nodes were free of tumor in 23 (77%) of 30 women. In six (86%) of seven women with tumor in sentinel nodes, the sentinel nodes were the only nodes with tumor. CONCLUSION: Sentinel node biopsy was successful in 30 women (91%) with nonpalpable infiltrating carcinoma diagnosed with percutaneous core biopsy and obviated axillary dissection in 23 women (70%). Using both radioisotope and blue dye may increase the success rate. A learning curve exists, and success improves with experience.
Adult↗
Percutaneous large-core biopsy of papillary breast lesions.
OBJECTIVE: This study was undertaken to assess the accuracy of percutaneous large-core biopsy in evaluating papillary breast lesions. MATERIALS AND METHODS: A retrospective review of imaging-guided large-core breast biopsy of 1077 consecutive lesions revealed that papillary lesions were diagnosed in 34 (3%) cases. Surgical correlation (n = 22) or minimum 2 years' mammographic follow-up (n = 4) were available for 26 papillary lesions. Mammographic and histologic findings in these 26 cases were reviewed. RESULTS: Percutaneous biopsy histology had benign findings in nine lesions, atypical in 10, and malignant in seven. Of seven lesions yielding benign papilloma at percutaneous biopsy, none (0%) had carcinoma at surgery or mammographic follow-up. Surgery revealed carcinoma in one of two lesions yielding papillomatosis at percutaneous biopsy. This lesion was a spiculated mass; surgical biopsy, recommended because of mammographic-histologic discordance, revealed a radial sclerosing lesion and ductal carcinoma in situ (DCIS). Of 10 papillary lesions with atypical ductal hyperplasia at percutaneous biopsy, surgery revealed DCIS in three (30%). Of seven lesions in which percutaneous biopsy yielded papillary DCIS, surgery revealed DCIS in all seven; three (43%) also had invasive carcinoma. CONCLUSION: Among our patients, diagnosis by percutaneous core biopsy of benign papillary lesions proved to be accurate when concordant with imaging findings. Surgical excision was indicated when diagnosis by percutaneous biopsy revealed atypical papillary lesions or papillary DCIS. A larger series with longer follow-up is required to assess the clinical course of benign papillary lesions without atypia that are not excised after percutaneous large-core breast biopsy.
Biopsy, Needle↗
Epithelial displacement after stereotactic 11-gauge directional vacuum-assisted breast biopsy.
OBJECTIVE: Displaced epithelial fragments at percutaneous biopsy of ductal carcinoma in situ (DCIS) may mimic stromal invasion. This study was undertaken to determine the frequency of epithelial displacement in DCIS lesions of patients who underwent stereotactic 11-gauge directional vacuum-assisted breast biopsy. MATERIALS AND METHODS: We retrospectively reviewed 28 consecutive DCIS lesions in patients who underwent stereotactic 11-gauge directional vacuum-assisted breast biopsy followed by surgery. Surgical specimens were examined for histologic evidence of epithelial displacement, consisting of fragments of epithelium in artifactual spaces in breast parenchyma or in lymphovascular channels, accompanied by hemorrhage, fat necrosis, inflammation, hemosiderin-laden macrophages, or granulation tissue. RESULTS: The median number of specimens obtained per lesion was 14 (range, seven to 45). The median interval from stereotactic biopsy to surgery was 27 days (range, 10-59 days). Surgery revealed DCIS in 19 (68%) of 28 lesions, DCIS and infiltrating carcinoma in four lesions (14%), and no residual carcinoma in five lesions (18%). Reactive changes at the biopsy site were identified in all cases. Displacement of benign epithelium into granulation tissue at the stereotactic biopsy site was identified in two cases (7%). We found no evidence of displacement of malignant epithelium. CONCLUSION: Epithelial displacement is uncommon after stereotactic 11-gauge directional vacuum-assisted biopsy of the breast. We observed displacement of benign epithelium in two (7%) of 28 DCIS lesions and no displacement of malignant epithelium.
Biopsy, Needle↗
Advanced Breast Biopsy Instrumentation (ABBI): analysis of published experience.
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Biopsy, Needle↗
Lobular carcinoma in situ at percutaneous breast biopsy: surgical biopsy findings.
OBJECTIVE: The purpose of this study was to review surgical histologic findings in women with lobular carcinoma in situ (LCIS) at percutaneous breast biopsy. MATERIALS AND METHODS: Retrospective review was performed of 1315 consecutive lesions that underwent percutaneous breast biopsy. Percutaneous biopsy yielded LCIS in 16 (1.2%) lesions. Subsequent surgical biopsy was performed in 14 lesions in 13 women. Histologic findings were reviewed. RESULTS: In five of the 14 lesions, percutaneous biopsy yielded LCIS and a high-risk lesion (radial scar in three and atypical ductal hyperplasia in two); in one (20%) of these five lesions, surgery revealed ductal carcinoma in situ (DCIS). In four of the 14 lesions, the LCIS in the percutaneous biopsy had features that overlapped with those of DCIS; in two (50%) of these four lesions, surgery revealed DCIS (n = 1) or infiltrating lobular carcinoma (n = 1). In the remaining five of the 14 lesions, surgery revealed no DCIS or infiltrating carcinoma. Five (38%) of 13 women with LCIS lesions had synchronous or metachronous infiltrating carcinoma (three ductal, one lobular, one mixed) in the ipsilateral (n = 1) or contralateral (n = 4) breast. CONCLUSION: Surgical excision was warranted in lesions in which LCIS was found at percutaneous breast biopsy when the percutaneous biopsy histologic features overlapped with those of DCIS, when a high-risk lesion was present, or when there was imaging-histologic discordance. LCIS without these factors was not shown to require surgical excision in our small series, but a larger study is needed. Diagnosis of LCIS at percutaneous biopsy is a marker for women who are at increased risk of ductal or lobular carcinoma in either breast.
Adult↗
Complete percutaneous excision of infiltrating carcinoma at stereotactic breast biopsy: how can tumor size be assessed?
OBJECTIVE: The purpose of this study was to determine the frequency of complete excision of infiltrating carcinoma at stereotactic 11-gauge directional vacuum-assisted breast biopsy and to evaluate the feasibility of measuring tumor size in stereotactic biopsy specimens in infiltrating carcinomas that were percutaneously excised. MATERIALS AND METHODS: We performed retrospective review of 51 infiltrating carcinomas diagnosed using stereotactic 11-gauge directional vacuum-assisted biopsy that underwent subsequent surgery. For lesions yielding no residual infiltrating carcinoma at surgery, the maximal dimension of the tumor was measured in stereotactic biopsy specimens using ocular micrometry. RESULTS: In 10 (20%) (95% confidence intervals, 9.8-33.1%) of 51 infiltrating carcinomas diagnosed at stereotactic biopsy, surgery revealed no residual infiltrating carcinoma. Complete excision of infiltrating carcinoma was more frequent if 14 or more specimens were obtained (32% versus 0%, p < .004), if the mammographic lesion was removed (35% versus 7%, p < .03), and if the mammographic lesion size measured 0.7 cm or less (50% versus 16%, p = .08). Tumor size in stereotactic biopsy specimens was within 3 mm of mammographic lesion size in six (60%) of 10 lesions, including five (71%) of seven masses and one (33%) of three calcification lesions, but was smaller than the mammographic lesion size in eight (80%) of 10 lesions. CONCLUSION: Surgery revealed no residual infiltrating carcinoma in 10 (20%) of 51 infiltrating carcinomas diagnosed at stereotactic 11-gauge biopsy. Although tumor size can be assessed in stereotactic biopsy specimens in these lesions, such measurements may underestimate the maximal dimension of the tumor. Further study is needed to evaluate the usefulness of these measurements in guiding treatment decisions.
Adult↗
A comparison of screening mammography results from programs for women of different socioeconomic status.
BACKGROUND: The ability of screening mammography programs serving women of different socioeconomic status (SES) to diagnose early stage breast carcinoma in a comparably effective fashion has been questioned. METHODS: Results of screening 50,653 women of lower SES were compared with those of screening 45,923 more socioeconomically advantaged women during the same period in New York State. Results were compared with those reported for the general population to the New York State cancer registry. RESULTS: Additional workup was required for approximately 12% of the women in each group. Although more women of lower SES underwent biopsy, the positive predictive value of a biopsy recommendation was almost the same for the two populations (27% for women of higher SES vs. 25% for women of lower SES). Among women with breast carcinoma, ductal carcinoma in situ was diagnosed in 27% of more affluent women and 15% of women of lower SES, a considerable improvement from the 10% rate of diagnosis in the general population in New York State. Minimal cancers accounted for 54% of those diagnosed in more affluent women and at least 31% of those diagnosed in women of lower SES. CONCLUSIONS: Screening mammography programs can be effective for women of lower SES and can be conducted as efficiently as they are for more affluent women. Differences in diagnosis of small cancers in the two groups reported in this article may reflect differences in age and patterns of prior screening experience in the two populations.
Adult↗
Percutaneous removal of malignant mammographic lesions at stereotactic vacuum-assisted biopsy.
PURPOSE: To determine whether complete percutaneous removal of a malignant lesion detected at mammography ensures complete excision of the carcinoma histopathologically. MATERIALS AND METHODS: A retrospective review was performed of 135 lesions in which stereotactic biopsy was performed with a directional, vacuum biopsy instrument and an 11-gauge probe followed by mammography. Carcinoma was diagnosed at stereotactic biopsy in 51 (38%) lesions. In 15 (29%) carcinomas, the lesion seen at mammography was removed at stereotactic biopsy. Surgical findings were available for correlation with biopsy and imaging findings in all 15 cases. Mammographic and histopathologic findings were reviewed. RESULTS: Mammographic findings were calcifications in 11 lesions and a mass in four lesions. The median lesion size was 0.7 cm (range, 0.2-1.4 cm), and the median number of biopsy specimens was 15 (range, 10-22 specimens). Histopathologic findings at stereotactic biopsy were ductal carcinoma in situ in 12 lesions and infiltrating ductal carcinoma in three. Surgery revealed residual carcinoma in 11 (73%) of 15 lesions, including all three infiltrating ductal carcinomas and eight of 12 ductal carcinoma in situ lesions. CONCLUSION: Complete removal of the mammographic lesion does not ensure complete excision of the carcinoma.
Biopsy, Needle↗
Calcification retrieval at stereotactic, 11-gauge, directional, vacuum-assisted breast biopsy.
PURPOSE: To determine the frequencies of calcification retrieval and histologic underestimates at stereotactic, 11-gauge, directional, vacuum-assisted breast biopsy. MATERIALS AND METHODS: Retrospective review of records revealed 112 calcific lesions in 80 women (aged 31-85 years) who underwent stereotactic, 11-gauge, directional, vacuum-assisted biopsy; a mean of 14 specimens per lesion were obtained. Calcification retrieval was defined as identification of calcifications on radiographs of specimens. Atypical ductal hyperplasia (ADH) underestimates were lesions that yielded ADH at stereotactic biopsy and carcinoma at surgery. Ductal carcinoma in situ (DCIS) underestimates were lesions that yielded DCIS at stereotactic biopsy and infiltrating carcinoma at surgery. Mammograms, stereotactic images, radiographs of specimens, and histologic findings were reviewed. RESULTS: Stereotactic, 11-gauge, directional, vacuum-assisted biopsy removed all calcifications in 51 (46%) lesions, some calcifications in 55 (49%) lesions, and no calcifications in six (5%) lesions. Failure to retrieve calcifications was significantly more likely in lesions 5 mm or smaller (12% [five of 43] vs 1% [one of 69], P = .03), in calcifications with amorphous morphology (21% [three of 14] vs 3% [three of 98], P < .03), or if the probe was fired outside the breast (12% [five of 40] vs 1% [one of 72], P = .02). Surgery revealed DCIS in one (10%) of 10 lesions that yielded ADH at stereotactic biopsy. Surgery revealed infiltrating carcinoma in one (5%) of 21 lesions that yielded DCIS at stereotactic biopsy. No underestimation occurred when all calcifications were removed. CONCLUSION: Stereotactic, 11-gauge, directional, vacuum-assisted biopsy resulted in successful calcification retrieval in 106 (95%) of 112 cases. Histologic underestimation was infrequent.
Adult↗
US-guided core breast biopsy: use and cost-effectiveness.
PURPOSE: To determine the frequency with which ultrasonographically (US) guided core biopsy obviated diagnostic surgical biopsy of nonpalpable breast masses, to calculate the cost savings of diagnosis attributable to US-guided core biopsy, and to compare the costs of US-guided versus stereotactically guided core biopsy. MATERIALS AND METHODS: US-guided core biopsy was performed in 151 consecutive solitary, nonpalpable breast masses in 151 women (age range, 23-80 years) by using a 14-gauge automated gun and needle. Clinical follow-up data were obtained. Cost savings were assessed by using national Medicare reimbursement costs of +385 for US-guided core biopsy, +610 for stereotactic core biopsy, and +1,332 for needle localization and surgical biopsy. RESULTS: US-guided core biopsy obviated a surgical procedure in 128 (85%) of 151 women. The mean adjusted direct cost saving per US-guided core biopsy was +744 per case. Use of US-guided biopsy decreased the cost of diagnosis by 56% (+744/+1,332) over the cost of surgical biopsy. If biopsy had been performed with stereotactic rather than with US guidance, the mean adjusted direct cost saving would have been +519 per case, a 39% (+519/1,332) decrease in the cost of diagnosis compared with the cost of surgical biopsy. CONCLUSION: Percutaneous biopsy of a nonpalpable breast mass with either US or stereotactic guidance is less expensive than surgery, but cost savings are greater with US-guided biopsy.
Adult↗
The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories.
OBJECTIVE: The purpose of the study was to assess the positive predictive value of mammographic features and final assessment categories described in the Breast Imaging Reporting and Data System (BI-RADS) for lesions on which biopsies have been performed. SUBJECTS AND METHODS: We prospectively evaluated 492 impalpable mammographically detected lesions on which surgical biopsy (as opposed to percutaneous biopsy) was performed. Each lesion was classified according to BI-RADS descriptors for masses (margins and shape) and calcifications (morphology and distribution) and was categorized by the BI-RADS final assessment categories as category 3 ("probably benign"), category 4 ("suspicious abnormality"), or category 5 ("highly suggestive of malignancy"). Mammographic and pathologic findings were reviewed. RESULTS: Carcinoma was present in 225 (46%) of 492 lesions. For the 492 lesions subject to biopsy, BI-RADS final assessment categories were category 3 in eight lesions (2%), category 4 in 355 (72%), and category 5 in 129 (26%). The features with highest positive predictive value for carcinoma were spiculated margins (81%), irregular shape (73%), linear calcification morphology (81%), and segmental or linear calcification distribution (74% and 68%, respectively). Carcinoma was present in 105 (81%) of 129 category 5 lesions compared with 120 (34%) of 355 category 4 lesions (p < .001). The frequency of carcinoma was higher in category 5 than in category 4 lesions for all mammographic lesion types and all interpreting radiologists. CONCLUSION: The standardized terminology of the BI-RADS lexicon allows quantification of the likelihood of carcinoma in an impalpable breast lesion. The features with highest positive predictive value--spiculated margins, irregular shape, linear morphology, and segmental or linear distribution--warrant designation of a lesion as category 5.
Adult↗
Stereotactic breast biopsy: indications and results.
Imaging-guided breast biopsy performed with large-core needles can accurately diagnose most breast pathologies, often allowing a diagnosis to be made more quickly and less expensively than with surgical biopsy. Major complications, such as hemorrhage and infection, are extremely rare, although post-biopsy ecchymosis and tenderness are not unusual. Because less tissue is removed, post-biopsy cosmetic deformity does not occur. Stereotactic biopsy is performed by triangulating the position of a breast lesion and by obtaining views angled equally off a central axis. This can be done using dedicated tables or add-on equipment. Stereotactic core biopsy has a reported accuracy of at least 90%. All lesions for which biopsy would ordinarily be recommended are amenable to stereotactic techniques, but those near the chest wall or in the axilla may be more difficult to biopsy with some equipment. Lesions characterized by calcifications are sometimes more difficult to sample. A biopsy diagnosis of ductal atypia, because of its histologic heterogeneity, requires surgical excision to exclude coexistent carcinoma, which has been found in half of women at subsequent surgical excision. A core biopsy diagnosis of ductal carcinoma in situ does not preclude the discovery of invasive carcinoma at surgery. In rare instances, the small tissue volume removed at stereotactic biopsy does not permit a final diagnosis to be made; this occurs most commonly when differentiating phyllodes tumor from fibroadenoma.
Biopsy, Needle↗
Patterns of mammographically detected calcifications after breast-conserving therapy associated with tumor recurrence.
BACKGROUND: Some authors have suggested that mammographically evident calcifications that would be considered benign in other situations can be due to carcinoma in women who have undergone breast conservation. This study was undertaken to determine if the pattern of calcifications associated with recurrent tumors detected mammographically differs from that observed in carcinomas developing de novo. METHODS: Mammograms of 22 cases of local tumor recurrence were retrospectively reviewed, and calcifications associated with recurrence were characterized according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) classification. RESULTS: Tumors were usually associated with > or = 10 calcifications (77%; 17 of 22 cases). Recurrences commonly contained very suspicious patterns of calcifications with linear forms present in 15 cases (68%) and pleomorphic calcifications present in 17 cases (77%). The distribution of calcifications was usually clustered (73%; 16 of 22 cases) or segmental (18%; 4 of 22 cases). Recurrences were usually obviously malignant (BI-RADS Category 5), and were characterized as such in 77% of cases. The remainder were indeterminate, requiring biopsy (BI-RADS Category 4). Recurrent tumors containing calcifications always contained some suspicious forms. Less worrisome types of calcifications were sometimes observed, including punctate calcifications in 36% and coarse calcifications in 14% of cases, but were always associated with more malignant patterns. CONCLUSIONS: Local tumor recurrences, when associated with mammographically evident calcifications, usually have a pattern highly suspicious for malignancy, although indeterminate forms can be the only calcifications present. Characteristically benign patterns of calcifications are not observed in recurrent tumors unless they are associated with more suspicious calcifications. Therefore, women without more worrisome patterns need not undergo biopsy because of the presence of these nonworrisome calcifications.
Breast Diseases↗