Mammographic casting‐type calcifications is not a prognostic factor in unifocal small invasive breast cancer: A population‐based retrospective cohort study

Månsson, Emeli; Bergkvist, Leif; Christenson, Gunilla; Persson, Carina; Wärnberg, Fredrik

doi:10.1002/jso.21405

Cited by 22 publications

(24 citation statements)

References 16 publications

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“…A subgroup of women within the study who presented with mammographic casting-type calcifications was found to have unexpectedly poor survival rates for this tumour-size category. Although this finding has been the subject of some debate in the literature (James et al , 2003; Evans et al , 2006; Mansson et al , 2009), other research groups have reported similar findings that support the work of Tabar et al (Thurfjell et al , 2001; Peacock et al , 2004). …”

supporting

confidence: 81%

Microcalcifications in breast cancer: novel insights into the molecular mechanism and functional consequence of mammary mineralisation

et al. 2012

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Background:Mammographic microcalcifications represent one of the most reliable features of nonpalpable breast cancer yet remain largely unexplored and poorly understood.Methods:We report a novel model to investigate the in vitro mineralisation potential of a panel of mammary cell lines. Primary mammary tumours were produced by implanting tumourigenic cells into the mammary fat pads of female BALB/c mice.Results:Hydroxyapatite (HA) was deposited only by the tumourigenic cell lines, indicating mineralisation potential may be associated with cell phenotype in this in vitro model. We propose a mechanism for mammary mineralisation, which suggests that the balance between enhancers and inhibitors of physiological mineralisation are disrupted. Inhibition of alkaline phosphatase and phosphate transport prevented mineralisation, demonstrating that mineralisation is an active cell-mediated process. Hydroxyapatite was found to enhance in vitro tumour cell migration, while calcium oxalate had no effect, highlighting potential consequences of calcium deposition. In addition, HA was also deposited in primary mammary tumours produced by implanting the tumourigenic cells into the mammary fat pads of female BALB/c mice.Conclusion:This work indicates that formation of mammary HA is a cell-specific regulated process, which creates an osteomimetic niche potentially enhancing breast tumour progression. Our findings point to the cells mineralisation potential and the microenvironment regulating it, as a significant feature of breast tumour development.

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confidence: 81%

Microcalcifications in breast cancer: novel insights into the molecular mechanism and functional consequence of mammary mineralisation

et al. 2012

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“…Several authors found an increased rate of deaths [1,6,12,13,19] with rate between 10 and 50%, others did not [10,20]. In our cohort only 15 of 99 lesions contained fine linear or fine-linear branching calcifications.…”

Section: Discussioncontrasting

confidence: 43%

Microcalcification-Associated Breast Cancer: Presentation, Successful First Excision, Long-Term Recurrence and Survival Rate

Rominger

Steinmetz

Westerman³

et al. 2015

Breast Care

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Introduction: In this study we evaluated mammographic, histological and immunohistochemical findings for microcalcification-associated breast cancer with regards to breast-conserving therapy, recurrence and survival rate. Patients and Methods: We retrospectively analyzed 99 consecutive, non-palpable and microcalcification-associated breast cancers (94 women) that were treated surgically between January 2002 and December 2003 at a national academic breast cancer center. Calcifications were classified according to the Breast Imaging Reporting and Data System (BI-RADS). Descriptors, surgical outcome and histological findings were assessed. Recurrences and survival rates were evaluated based on medical records, standardized patient questionnaires and/or contacting the physician. Results: 42 of the 99 lesions (42.4%) were invasive carcinomas, 57 (57.6%) were pure ductal carcinoma in situ (DCIS). 6 out of 99 (6.1%) lesions were triple negative, and 29 (29.3%) were HER2/neu positive. Successful first excision rate was 76/99 lesions (76.8%). Breast conservation was achieved in 73.7% (73/99). 10 women showed local recurrences without negatively impacting survival. The recurrences included round/punctate, amorphous, fine pleomorphic, and fine linear or fine-linear branching descriptors. The breast cancer-specific long-term survival rate was 91/94 (96.8%) for a mean follow-up of 81.4 months. The 3 patients who died due to breast carcinoma showed fine pleomorphic calcifications, and had nodal-positive invasive carcinoma at diagnosis. Conclusion: Microcalcification-associated breast cancers are frequently treated with breast-conserving therapy. Continuous clinical and mammographic follow-up is recommended for all descriptors.

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“…Thurfjell et al (16) revealed that mammographic appearance presenting as casting or pleomorphic calcifications alone had a significantly worse prognosis than other types of mammographic appearance in small invasive breast cancer, which was confirmed by the later series studies (14,15). Conversely, there are certain studies doubting the ability of mammographic calcification to predict the survival outcomes of patients (21–23). In the present study, the outcome of 409 breast cancer patients with or without calcification, who had received BCS and post-surgery adjuvant treatment, were retrospectively studied.…”

Section: Discussionmentioning

confidence: 99%

Mammographic calcification can predict outcome in women with breast cancer treated with breast-conserving surgery

Chen

Zhang

et al. 2017

Oncology Letters

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The impact of calcification in patients with breast carcinoma treated with breast-conserving surgery (BCS) is unclear. The present study aimed to determine the outcome of breast cancer patients with calcification treated with BCS. The records of 409 patients with breast carcinoma treated with BCS from January 2005 to December 2008 were reviewed. Patients were categorized as those with calcification (on mammography or ultrasonography), or those without calcification (neither on mammography nor ultrasonography). The local relapse free survival time (LRFS), disease free survival time (DFS) and overall survival time (OS) were compared, and subgroup analysis was performed based on morphological types and distribution patterns of mammographic calcification. Survival analysis demonstrated that patients with calcification had a significantly increased risk of local recurrence, distant metastasis and mortality compared with those without calcification [relative risk (RR) and 95% confidence interval (CI): local recurrence, 2.46 and 1.11–5.44; distant metastasis, 2.24 and 1.19–4.24; mortality, 2.50 and 1.06–5.86]. Subgroup analysis revealed that the distribution patterns (rather than morphological types of calcification) accounted for the increased risk of recurrence following BCS. Patients with mammographic calcification of liner/segmental distribution had significantly decreased LRFS (RR=6.20; 95% CI, 2.26–16.98), DFS (RR=6.81; 95% CI, 2.86–16.20) and OS (RR=9.14; 95% CI, 2.53–33.00), while patients with mammographic calcification of clustered distribution did not have significantly decreased LRFS, DFS and OS (P>0.05), compared with those without calcification. In addition, the mammographic calcification spreading along the ducts was more likely to be accompanied by an extensive intraductal component (P<0.001). Finally, the outcome of patients with calcification on breast ultrasound was as good as those without calcification. Patients with mammographic calcification, particularly those with calcification spreading along the ducts, have a higher risk of recurrence following BCS, which has a negative impact on long-term survival. Calcification identified on breast ultrasonography does not affect the survival of patients treated with BCS.

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Mammographic casting‐type calcifications is not a prognostic factor in unifocal small invasive breast cancer: A population‐based retrospective cohort study

Cited by 22 publications

References 16 publications

Microcalcifications in breast cancer: novel insights into the molecular mechanism and functional consequence of mammary mineralisation

Microcalcifications in breast cancer: novel insights into the molecular mechanism and functional consequence of mammary mineralisation

Microcalcification-Associated Breast Cancer: Presentation, Successful First Excision, Long-Term Recurrence and Survival Rate

Mammographic calcification can predict outcome in women with breast cancer treated with breast-conserving surgery

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