A cluster of microcalcifications: women with high risk for breast cancer versus other women.
ABSTRACT Abnormal screening mammographic findings are the most common presentation of ductal carcinoma in situ, which usually appears as a cluster of microcalcifications. No report has documented the risk of malignancy between the finding of a cluster of microcalcifications and women with high risk of breast cancer.
We investigated the morphologic descriptors of a cluster of microcalcifications in women with a high risk for breast cancer and compared the results with the characteristics of a cluster of microcalcifications in other women. A retrospective review was performed for 81 non-palpable clusters of microcalcifications that had stereotactic vacuum-assisted breast biopsy.
The frequency of malignancy associated with a cluster of microcalcifications was 27%. The 50% frequency of malignancy with high risk for breast cancer was higher, but not significantly so, than the 24% frequency of 71 cases without high risk for breast cancer (P = 0.125). The frequency of malignancy and ADH of a cluster of microcalcifications with high risk of breast cancer was 70%, significantly higher than the 30% frequency of 71 cases without high risk of breast cancer (P = 0.028).
A cluster of microcalcifications in women with high risk for breast cancer should be considered suspicious and referred for biopsy.
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ABSTRACT: To prospectively evaluate whether dynamic contrast-enhanced magnetic resonance (MR) imaging findings can help predict the presence of malignancy when screening detected microcalcification lesions, and its contribution to patient management of stereotactic vacuum-assisted breast biopsy (SVAB). Dynamic contrast-enhanced breast MR imaging was performed when screening 100 detected microcalcification lesions not visualized by ultrasonography with 11-gauge SVAB. Definitive surgery was performed on all patients with the biopsy resulting in the diagnosis of breast cancer or atypical ductal hyperplasia (ADH). Positive predictive values (PPVs) and negative predictive values (NPVs) were calculated on the basis of a BI-RADS (Breast Imaging Reporting and Data System) category and the absence or presence of contrast uptake in the area of microcalcification. The BI-RADS mammography category correlated with the diagnosis of breast cancer (ADH excluded): category 3 = 7% (4/55); category 4 = 48% (13/27); category 5 = 94% (17/18). After dynamic contrast-enhanced MR imaging, three of four malignancies with BI-RADS mammography category 3 were diagnosed as true positive. Therefore, the PPV of BI-RADS mammography category 3 with MR imaging was 1.8% (1/55). The PPV of contrast uptake of MR imaging was 86% (32/37), significantly higher than the 67% (30/45) PPV of BI-RADS mammography 4 and 5 (P = 0.033). The NPV of BI-RADS mammography 3 was 93% (51/55) versus 97% (61/63) NPV of MR imaging (P = 0.167). In the evaluation of screening detected microcalcification lesions, dynamic contrast-enhanced breast MR imaging provides additional information with high PPV and NPV, and may therefore offer an alternative to SVAB for women who do not want to undergo SVAB with equivocal findings following full diagnostic mammographic assessment, but breast MR imaging with imperfect PPV and NPV cannot replace SVAB. Dynamic contrast-enhanced breast MR imaging can demonstrate malignant microcalcifications detected by screening mammography and can be recommended in the evaluation of equivocal microcalcifications prior to SVAB.Breast Cancer Research and Treatment 08/2007; 103(3):269-81. · 4.47 Impact Factor
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