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Independent predictors of breast malignancy in screen-detected microcalcifications: biopsy results in 2545 cases.
Br J Cancer. 2011 Nov 22; 105(11):1669-75.BJ

Abstract

BACKGROUND

Mammographic microcalcifications are associated with many benign lesions, ductal carcinoma in situ (DCIS) and invasive cancer. Careful assessment criteria are required to minimise benign biopsies while optimising cancer diagnosis. We wished to evaluate the assessment outcomes of microcalcifications biopsied in the setting of population-based breast cancer screening.

METHODS

Between January 1992 and December 2007, cases biopsied in which microcalcifications were the only imaging abnormality were included. Patient demographics, imaging features and final histology were subjected to statistical analysis to determine independent predictors of malignancy.

RESULTS

In all, 2545 lesions, with a mean diameter of 21.8 mm (s.d. 23.8 mm) and observed in patients with a mean age of 57.7 years (s.d. 8.4 years), were included. Using the grading system adopted by the RANZCR, the grade was 3 in 47.7%; 4 in 28.3% and 5 in 24.0%. After assessment, 1220 lesions (47.9%) were malignant (809 DCIS only, 411 DCIS with invasive cancer) and 1325 (52.1%) were non-malignant, including 122 (4.8%) premalignant lesions (lobular carcinoma in situ, atypical lobular hyperplasia and atypical ductal hyperplasia). Only 30.9% of the DCIS was of low grade.Mammographic extent of microcalcifications >15 mm, imaging grade, their pattern of distribution, presence of a palpable mass and detection after the first screening episode showed significant univariate associations with malignancy. On multivariate modeling imaging grade, mammographic extent of microcalcifications >15 mm, palpable mass and screening episode were retained as independent predictors of malignancy. Radiological grade had the largest effect with lesions of grade 4 and 5 being 2.2 and 3.3 times more likely to be malignant, respectively, than grade 3 lesions.

CONCLUSION

The radiological grading scheme used throughout Australia and parts of Europe is validated as a useful system of stratifying microcalcifications into groups with significantly different risks of malignancy. Biopsy assessment of appropriately selected microcalcifications is an effective method of detecting invasive breast cancer and DCIS, particularly of non-low-grade subtypes.

Authors+Show Affiliations

BreastScreen SA and SA Pathology, 1 Goodwood Road, Wayville, South Australia, Australia. gelareh.farshid@health.sa.gov.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22052156

Citation

Farshid, G, et al. "Independent Predictors of Breast Malignancy in Screen-detected Microcalcifications: Biopsy Results in 2545 Cases." British Journal of Cancer, vol. 105, no. 11, 2011, pp. 1669-75.
Farshid G, Sullivan T, Downey P, et al. Independent predictors of breast malignancy in screen-detected microcalcifications: biopsy results in 2545 cases. Br J Cancer. 2011;105(11):1669-75.
Farshid, G., Sullivan, T., Downey, P., Gill, P. G., & Pieterse, S. (2011). Independent predictors of breast malignancy in screen-detected microcalcifications: biopsy results in 2545 cases. British Journal of Cancer, 105(11), 1669-75. https://doi.org/10.1038/bjc.2011.466
Farshid G, et al. Independent Predictors of Breast Malignancy in Screen-detected Microcalcifications: Biopsy Results in 2545 Cases. Br J Cancer. 2011 Nov 22;105(11):1669-75. PubMed PMID: 22052156.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Independent predictors of breast malignancy in screen-detected microcalcifications: biopsy results in 2545 cases. AU - Farshid,G, AU - Sullivan,T, AU - Downey,P, AU - Gill,P G, AU - Pieterse,S, Y1 - 2011/11/03/ PY - 2011/11/5/entrez PY - 2011/11/5/pubmed PY - 2012/3/20/medline SP - 1669 EP - 75 JF - British journal of cancer JO - Br J Cancer VL - 105 IS - 11 N2 - BACKGROUND: Mammographic microcalcifications are associated with many benign lesions, ductal carcinoma in situ (DCIS) and invasive cancer. Careful assessment criteria are required to minimise benign biopsies while optimising cancer diagnosis. We wished to evaluate the assessment outcomes of microcalcifications biopsied in the setting of population-based breast cancer screening. METHODS: Between January 1992 and December 2007, cases biopsied in which microcalcifications were the only imaging abnormality were included. Patient demographics, imaging features and final histology were subjected to statistical analysis to determine independent predictors of malignancy. RESULTS: In all, 2545 lesions, with a mean diameter of 21.8 mm (s.d. 23.8 mm) and observed in patients with a mean age of 57.7 years (s.d. 8.4 years), were included. Using the grading system adopted by the RANZCR, the grade was 3 in 47.7%; 4 in 28.3% and 5 in 24.0%. After assessment, 1220 lesions (47.9%) were malignant (809 DCIS only, 411 DCIS with invasive cancer) and 1325 (52.1%) were non-malignant, including 122 (4.8%) premalignant lesions (lobular carcinoma in situ, atypical lobular hyperplasia and atypical ductal hyperplasia). Only 30.9% of the DCIS was of low grade.Mammographic extent of microcalcifications >15 mm, imaging grade, their pattern of distribution, presence of a palpable mass and detection after the first screening episode showed significant univariate associations with malignancy. On multivariate modeling imaging grade, mammographic extent of microcalcifications >15 mm, palpable mass and screening episode were retained as independent predictors of malignancy. Radiological grade had the largest effect with lesions of grade 4 and 5 being 2.2 and 3.3 times more likely to be malignant, respectively, than grade 3 lesions. CONCLUSION: The radiological grading scheme used throughout Australia and parts of Europe is validated as a useful system of stratifying microcalcifications into groups with significantly different risks of malignancy. Biopsy assessment of appropriately selected microcalcifications is an effective method of detecting invasive breast cancer and DCIS, particularly of non-low-grade subtypes. SN - 1532-1827 UR - https://www.unboundmedicine.com/medline/citation/22052156/Independent_predictors_of_breast_malignancy_in_screen_detected_microcalcifications:_biopsy_results_in_2545_cases_ L2 - https://doi.org/10.1038/bjc.2011.466 DB - PRIME DP - Unbound Medicine ER -