Non‐palpable breast carcinomas: Correlation of mammographically detected malignant‐appearing microcalcifications and molecular prognostic factors

Abstract

Screening mammography has greatly increased the number of non-palpable breast carcinomas diagnosed in asymptomatic women. Malignant-appearing microcalcifications represent one of the earliest mammographic findings of nonpalpable breast carcinomas. Many studies have attempted to correlate radiological and histological features of malignantappearing microcalcifications. In the present study, we evaluated the association between mammographically detected malignant-appearing microcalcifications and the expression profile of selected biological markers in non-palpable breast carcinomas. Two hundred and eighty patients with non-palpable suspicious breast lesions that were detected during screening mammography were studied. All patients underwent mammographically-guided needle localization-excision breast biopsy. Key words: non-palpable breast carcinoma; microcalcification; estrogen receptor; progesterone receptor; c-erbB-2; cell proliferation; apoptosisBreast carcinoma represents a common disease among Greek women and is considered to be one of the main causes of cancer mortality. In the last decade screening programs have been intensified in Greece, based on 8 randomized breast screening trials that have suggested a contribution of mammographic screening to breast cancer mortality, 1 although debate continues on this issue. 2 The main goal of these programs is the detection of breast carcinomas in an earlier and more curable stage of evolution. 3 Noteworthy is the fact that with the introduction of mammographic screening, the incidence of ductal carcinoma in situ (DCIS) in asymptomatic women has increased to 20 -25% of all screeningdetected breast cancers. 4 It has been estimated that mammographic detection of non-palpable breast carcinomas reflects only 20% of the "total lifetime" of breast cancer. 5 Mammographically-diagnosed non-palpable breast carcinomas are increasingly encountered and constitute a major clinical entity.Non-palpable breast carcinomas form a heterogeneous group of lesions with variable findings and different prognosis. Most are small in size and have infrequent nodal and distant metastases. It is well documented that microcalcifications represent one of the earliest mammographically detectable changes associated with in situ and invasive breast carcinomas in asymptomatic women. Microcalcifications are the primary indication for approximately 50% of the breast biopsies carried out for non-palpable mammographic abnormalities, although they do not always represent malignancy. Various investigators have attempted to distinguish mammographically benign vs. malignant microcalcifications. 6 Histologic examination of the areas of microcalcifications is not always adequate in terms of clinical decision making. 7 New parameters for mammographically detected microcalcifications associated with non-palpable breast carcinomas are desirable.A wide range of prognostic markers have been proposed for non-palpable breast carcinomas. The clinically available markers such as histological type, size, auxiliary node ...

Correlation of Mammographic Calcifications with HER-2/neu Overexpression in Primary Breast Carcinomas

“…Two prior reports have shown a correlation between malignant-appearing microcalcifications and HER-2/neu overexpression in ductal carcinoma in situ (DCIS) and nonpalpable breast carcinomas. Malignant-appearing microcalcifications was the major mammographic finding in nonpalpable breast carcinomas, and statistically significant associations were found between malignant-appearing microcalcifications and HER-2/neu overexpression in the study by Karamauzis et al 2 . Evans et al 5 reported that DCIS with HER-2/neu overexpression had higher frequency of calcifications than those without HER-2/neu overexpression, and HER-2/neu positive DCIS showed the following features more commonly than HER-2/neu negative disease: calcification, ductal distribution of calcification, rodshaped calcification, and granular calcification.…”

“…It is well documented that calcifications represent one of the earliest mammographically detectable changes associated with in situ and invasive breast carcinomas in asymptomatic women. 2,9 Fondrinier and co-workers 10 reported a 47% incidence of malignancy in 204 women with mammographic files showing clustered calcifications.…”

“…Previous studies have attempted to evaluate and interpret the clinical perspective of the relationship between mammographic calcifications and the expression of selected biological markers, such as ER, PR, Bax, Fas, Bcl-2, and DNA fragmentation factor in breast carcinomas. 1,2 Amplification of HER-2/neu is considered as an independent poor prognostic factor in invasive breast 1 From the Department of Breast Cancer, Jinan Central Hospital, Medical College, Shandong University, Jinan 250013, China. 2 carcinomas and has been associated with altered clinical responsiveness to systemic breast cancer treatment such as chemotherapy and antiestrogens.…”

“…1,2 Amplification of HER-2/neu is considered as an independent poor prognostic factor in invasive breast 1 From the Department of Breast Cancer, Jinan Central Hospital, Medical College, Shandong University, Jinan 250013, China. 2 carcinomas and has been associated with altered clinical responsiveness to systemic breast cancer treatment such as chemotherapy and antiestrogens. 3 The reported range of patients found to be overexpressed for HER-2/neu by immunohistochemistry is 20-68%.…”

“…3 The reported range of patients found to be overexpressed for HER-2/neu by immunohistochemistry is 20-68%. 2,4,5 Some investigators have attempted to evaluate the association between mammographic calcifications and HER-2/neu overexpression. Two prior reports have shown a correlation between malignant-appearing microcalcifications and HER-2/neu overexpression in ductal carcinoma in situ (DCIS) and nonpalpable breast carcinomas.…”