Diagnostic and Interventional Radiology
Breast Imaging - Original Article

Predictive factors for invasive cancer in surgical specimens following an initial diagnosis of ductal carcinoma in situ after stereotactic vacuum-assisted breast biopsy in microcalcification-only lesions

1.

Department of Radiology, Dicle University Medical School, Diyarbakır, Turkey

2.

Department of Radiology, Maidstone Hospital, Maidstone, UK

3.

Department of Pathology, Maidstone Hospital, Maidstone, UK

4.

Department of General Surgery, Dicle University Medical School, Diyarbakır, Turkey

5.

Department of Surgery, Maidstone Hospital, Maidstone, UK

6.

Department of Radiology Hacettepe University Medical School, Ankara, Turkey

Diagn Interv Radiol 2016; 22: 29-34
DOI: 10.5152/dir.2015.14453
Read: 772 Downloads: 222 Published: 03 September 2019

Abstract

PURPOSE

The aim of this study was to determine the incidence of invasive breast carcinoma in patients with preoperative diagnosis of ductal carcinoma in situ (DCIS) by stereotactic vacuum-assisted biopsy (SVAB) performed for microcalcification-only lesions, and to identify the predictive factors of invasion.

 

METHODS

From 2000 to 2010, the records of 353 DCIS patients presenting with microcalcification-only lesions who underwent SVAB were retrospectively reviewed. The mammographic size of microcalcification cluster, presence of microinvasion within the cores, the total number of calcium specks, and the number of calcium specks within the retrieved core biopsy specimen were recorded. Patients were grouped as those with or without invasion in the final pathologic report, and variables were compared between the two groups.

 

RESULTS

The median age was 58 years (range, 34–88 years). At histopathologic examination of the surgical specimen, 63 of 353 patients (17.8%) were found to have an invasive component, although SVAB cores had only shown DCIS preoperatively. The rate of underestimation was significantly higher in patients with microcalcification covering an area of 40 mm or more, in the presence of microinvasion at biopsy, and in cases where less than 40% of the calcium specks were removed from the lesion.

 

CONCLUSION

Invasion might be underestimated in DCIS cases diagnosed with SVAB performed for microcalcification-only lesions, especially when the mammographic size of calcification is equal to or more than 40 mm or if microinvasion is found within the biopsy specimen and less than 40% of the calcifications are removed. At least 40% of microcalcification specks should be removed from the lesion to decrease the rate of underestimation with SVAB. 

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