Mammographic Appearance of Nonpalpable Breast Cancer Reflects Pathologic Characteristics

Abstract

ObjectiveTo study the relationship of mammographic appearance of nonpalpable breast cancer to the pathologic characteristics. Summary Background DataThe mammographic appearance of nonpalpable breast cancer may be associated with pathologic variables having prognostic significance, which could influence clinical management. MethodsThe authors correlated the mammographic appearance and pathologic characteristics of 543 nonpalpable malignancies diagnosed in a single institution between July 1993 and July 1999. Cancers were divided into four groups based on mammographic presentation: mass, calcification, mass with calcification, and architectural distortion. ResultsThe majority of masses (95%), masses with calcifications (68%), and architectural distortions (79%) were due to invasive cancers, whereas the majority of calcifications (68%) were due to ductal carcinoma in situ (DCIS). Among invasive cancers, calcifications were associated with more extensive intraductal carcinoma, more Her2/neu immunoreactivity, and more necrosis of DCIS. Lymphatic invasion was more common in cancers presenting as a mass with calcifications. Sixty-nine percent of DCIS associated with invasive cancers presenting as calcifications were of high grade according to the European Organization for Research and Treatment of Cancer. Calcifications in noninvasive tumors were associated with necrosis in DCIS. Two thirds of cancers presenting as architectural distortion had positive margins (65%) compared with 35% to 37% of other mammographic presentations. Mammographic presentation was not significantly related to tumor differentiation or estrogen or progesterone receptor status. The ratio of invasive to noninvasive malignancies increased progressively with increasing age from 1:1 in patients younger than 50 years of age to 3:1 in patients older than 70 years, whereas the proportion presenting as calcifications declined from 63% in patients younger than 50 years to 26% in patients older than 70 years. ConclusionsMalignancies presenting as calcifications on mammography are most commonly DCIS. When invasive malignancies presented as calcifications, the calcifications were associated with accompanying high-grade DCIS, and the invasive cancers were often Her2/Neu positive. Mammographic masses with calcifications were associated with lymphatic invasion. Excisional biopsy margins were most commonly positive with architectural distortions. The mammographic appearance of nonpalpable malignancies is related to pathologic characteristics with prognostic value, which varies with patient age and influences clinical management.

Correlation between mammographic and sonographic findings and prognostic factors in patients with node-negative invasive breast cancer

“…To our knowledge, there have been several studies on the association between mammographic features and the prognostic or pathological characteristics of breast cancer [22][23][24][25]27], but only two studies have been published on the association between sonographic features and the histological grade of invasive breast cancer [21,26]. As far as we know, no report has been published on the association between the mammographic and sonographic features analysed according to the BI-RADS lexicon and the pathological characteristics of node-negative invasive breast cancer.…”

“…Gajdos et al [23] carried out a study of 543 nonpalpable breast cancers, and demonstrated that lymphatic invasion was more common in cancers presenting as a mass with calcifications. In our study, mammographic types that were significantly associated with LVI were spiculated or non-spiculated masses with calcifications.…”

“…Specifically, associated calcifications on both mammography and sonography were the most important finding in detecting an EIC. Gajdos et al [23] showed that no specific mammographic finding was significantly related to ER or progesterone receptor (PR) status. However, we found that mammographic findings of lesions with non-spiculated margins (e.g.…”

“…Several studies have looked at the correlation between imaging findings and prognostic factors [18,[21][22][23][24][25][26][27]. To our knowledge, however, no report has correlated imaging findings in node-negative invasive breast cancers that were analysed according to the Breast Imaging Report and Data System (BI-RADS) lexicon with prognostic factors.…”

Assessment of the extent of microcalcifications to predict the size of a ductal carcinoma in situ: comparison between tomosynthesis and conventional mammography

“…Grouped microcalcifications in mammograms (MG) and digital tomosynthesis of the breast (DBT) are the best signs of a potentially underlying DCIS or an invasive cancer. Further examinations like a core needle biopsy or vacuumassisted biopsy are needed for clarification or exclusion of malignancy [6]. However in up to 40% (mostly in low grade DCIS) no calcifications can be seen [7].…”