Highlights
- •Benign and malignant calcifications can develop in the ipsilateral breast after BCS.
- •PPV of sampled calcifications following BCS for non-calcified primary was 12.8%.
- •PPV of sampled calcifications following BCS for calcified primary was 38.5%.
- •Suspicious calcifications following BCS require biopsy.
Abstract
Objective
The objective of our study was to determine whether, in the digital era, imaging features
of a primary breast tumor can be used to influence the decision to biopsy ipsilateral
breast calcifications that occur following surgery in women treated with breast conservation
surgery (BCS).
Materials and methods
We retrospectively identified women treated with BCS who subsequently developed suspicious
calcifications in the treated breast (BI-RADS 4 or 5) from January 2012 – December
2018. Only cases with histopathological diagnosis by stereotactic or surgical biopsy
were included. Pathology reports were reviewed, and biopsy results were considered
malignant if invasive carcinoma or ductal carcinoma in situ (DCIS) was found. All
other results were considered benign.
Fisher's exact test was done comparing frequencies of malignancy between those patients
whose original tumor had calcifications versus those whose original tumors were not
calcified.
Results
Of 90 women with suspicious calcifications on a post-BCS mammogram, 65 (72.2%) were
biopsy proven benign and 25 (27.8%) were malignant. The original tumor presented without
calcifications in 39 patients (43%), and 51 (57%) had calcifications with or without
associated mass, focal asymmetry, or architectural distortion. New calcifications
were less likely to be malignant if the original tumor presented without calcifications
(5/39; 12.8%) as compared to original tumors with calcifications (20/51; 38.5%) [p-value < 0.05].
Conclusion
New calcifications after BCS are significantly less likely to be malignant if the
original tumor presented without calcifications. However, with a PPV of 12.8%, even
calcifications in a patient with a non-calcified primary tumor require biopsy.
Keywords
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References
- Prognostic and predictive factors in early-stage breast cancer.Oncologist. 2004; 9: 606-616
- Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer.N Engl J Med. 1989; 320: 822-828
- Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer.Radiother Oncol. 1989; 14: 177-184
- Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer.N Engl J Med. 2002; 347: 1227-1232
- New trends in breast cancer surgery: a therapeutic approach increasingly efficacy and respectful of the patient.G Chir. 2015; 36: 145-152
- Increasing trends in the use of breast-conserving surgery in California.Am J Public Health. 2000; 90: 281-284
- The mammographic spectrum of fat necrosis of the breast.Radiographics. 1995; 15: 1347-1356
- Breast microcalcifications after lumpectomy and radiation therapy.Radiology. 1989; 170: 691-693
- Comparison of rate of development and rate of change for benign and malignant breast calcifications at the lumpectomy bed.AJR Am J Roentgenol. 2000; 175: 789-793
- Mammographic detection of recurrent cancer in the irradiated breast.AJR Am J Roentgenol. 1987; 148: 39-43
- Early breast cancer: detection of recurrence after conservative surgery and radiation therapy.Radiology. 1990; 176: 731-735
- Local tumor recurrence following breast-conservation therapy: correlation of histopathologic findings with detection method and mammographic findings.Radiology. 1999; 212: 829-835
- Mammographic findings of recurrent breast cancer after lumpectomy and radiation therapy: comparison with the primary tumor.Radiology. 1996; 201: 767-771
- Biopsy results of new calcifications in the postirradiated breast.Cancer. 1989; 63: 1956-1961
- Time-course of local recurrence following conservative surgery and radiotherapy for early stage breast cancer.Int J Radiat Oncol Biol Phys. 1988; 15: 255-261
- Management of microcalcifications developing at the lumpectomy bed after conservative surgery and radiation therapy.AJR Am J Roentgenol. 2007; 188: 393-398
- Patterns of mammographically detected calcifications after breast-conserving therapy associated with tumor recurrence.Cancer. 1997; 79: 1355-1361
- Mammographic features of local recurrence in women who have undergone breast-conserving therapy for ductal carcinoma in situ.AJR Am J Roentgenol. 1997; 168: 489-493
- Full-field digital versus screen-film mammography: comparative accuracy in concurrent screening cohorts.AJR Am J Roentgenol. 2007; 189: 860-866
- Calcifications in digital mammographic screening: improvement of early detection of invasive breast cancers?.Radiology. 2010; 255: 738-745
- Differentiation of benign and malignant local tumor recurrence after lumpectomy.AJR Am J Roentgenol. 1990; 155: 35-38
Article info
Publication history
Published online: January 19, 2021
Accepted:
January 15,
2021
Received in revised form:
December 22,
2020
Received:
October 15,
2020
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
