X-Ray Calcifications as the Only Basis for Breast Biopsy

Abstract

Two hundred fifty-one consecutive patients were treated between 1964 and 1982 with mammographic calcifications as the only reason for breast biopsy. Patients with either clinical or x-ray findings other than calcifications were excluded. A correlation of the x-ray, pathology, and clinical experience is the basis of this report. Specimen radiography with paraffin section histology (i.e., no frozen section) was performed on all biopsy material. The procedure of specimen radiography that was utilized is described. A team approach involving radiologists, pathologists, and surgeons has been essential both to confirm excision of the calcifications and localize them for pathology study. Carcinoma was found in 45 patients (17%). A retrospective study of the calcifications was also undertaken to determine characteristics that would permit definitive radiographic diagnosis of benign or malignant disease.

Biopsy sampling of breast lesions: comparison of core needle- and vacuum-assisted breast biopsies

“…Benign breast calcifications are smooth, round, dense, and scattered over a large area, whereas malignant calcifications show clustered or linear morphology or can be large and pleomorphic, even though overlap exists [13,14]. Many authors have reported that the number of calcifications within an area is an important parameter of clustered calcification, indicating that when the number of calcification is low (less than 5 per 0.25 cm 2 ), less than five per cluster, or when present in loose cluster, the lesions are very unlikely to be malignant [15][16][17]. There are two processes in which calcifications are formed in the breast: secretory type, which is related to secretion accumulation, and hence likely to be found in benign lesions or low grade malignancies; and necrotic type caused by rapidly proliferating tumor cells depleted of vascular supply found in comedo necrosis [18].…”

Intermediate to highly suspicious calcification in breast lesions: a radio-pathologic correlation

“…The definition of clustered calcification is taken as more than 5 microcalcifications in an area of 1 cm 2 , or an area of 0.5 cm · 0.5 cm or in the volume of 1 cc [42][43][44].There is however considerable overlap between benign and malignant lesions with clustered calcifications, making this morphological description somewhat non discriminatory (Figs. 3, 4).…”

“…To enhance the discriminatory power of clustered calcification, many authors have reported that the number of calcifications within an area is an important parameter of clustered calcifications. When the number of calcification is low (less than 5 per 0.25 cm 2 [43], or less than five per cluster [44], or when the calcifications are present in a loose cluster [45]), the lesions are very unlikely to be malignant. In addition, other associated parameters have been reported to be important in predicting malignancy, and these include pleomorphism of the calcification, architectural distortion, associated mass and associated density.…”

Breast Biopsy for Calcifications in Nonpalpable Breast Lesions

“…Age at first birth, y* 10-20_12 (15)_2 (7) 20-30_53 (68)_18 (64) 30-40_13 (17)_7 (25) >40_0 (0)_1 (4) No. of pregnancies 0 94 (54) 39 (59) t-2_27 (16)_13 (20) 3-4_38 (22)_7 (11) 5-6_11 (6)_4 (6) >6_3 (2)_3 (4) Prior breast problems 41 (24) 18 (27) Family history_28 (16)_11 (17) White_154 (89) The site of origin of all lesions was reviewed (Fig 1) …”