Abstract
BackgroundMicrocalcifications (MCs) are tiny deposits of calcium in breast soft tissue. Approximately 30% of early invasive breast cancers have fine, granular MCs detectable on mammography; however, their significance in breast tumorigenesis is controversial. This study had two objectives: (1) to find associations between mammographic MCs and tumor pathology, and (2) to compare the diagnostic value of mammograms and breast biopsies in identifying malignant MCs.MethodsA retrospective chart review was performed for 937 women treated for breast cancer during 2000–2012 at St. Michael’s Hospital. Demographic information (age and menopausal status), tumor pathology (size, histology, grade, nodal status and lymphovascular invasion), hormonal status (ER and PR), HER-2 over-expression and presence of MCs were collected. Chi-square tests were performed for categorical variables and t-tests were performed for continuous variables. All p-values less than 0.05 were considered statistically significant.ResultsA total of 937 patient charts were included. About 38.3% of the patients presented with mammographic MCs on routine mammographic screening. Patients were more likely to have MCs if they were HER-2 positive (52.9%; p < 0.001). There was a significant association between MCs and peri-menopausal status with a mean age of 50 (64%; p = 0.012). Patients with invasive ductal carcinomas (40.9%; p = 0.001) were more likely to present with MCs than were patients with other tumor histologies. Patients with a heterogeneous breast density (p = 0.031) and multifocal breast disease (p = 0.044) were more likely to have MCs on mammograms. There was a positive correlation between MCs and tumor grade (p = 0.057), with grade III tumors presenting with the most MCs (41.3%). A total of 52.2% of MCs were missed on mammograms which were visible on pathology (p < 0.001).ConclusionThis is the largest study suggesting the appearance of MCs on mammograms is strongly associated with HER-2 over-expression, invasive ductal carcinomas, peri-menopausal status, heterogeneous breast density and multifocal disease.
Highlights
Microcalcifications (MCs) are tiny deposits of calcium in breast soft tissue
Our study indicates that presence of both malignant and benign mammographic MCs is associated with poor prognostic factors of breast cancer, and could serve as indicators of aggressive tumor growth
Wang et al [10] conducted a retrospective study of 152 patients, and found MCs were more common in carcinomas with Human epidermal growth factors receptor 2 (HER-2) over-expression at a prevalence of 61.6% compared to those without HER-2 at 35.4%
Summary
Microcalcifications (MCs) are tiny deposits of calcium in breast soft tissue. This study had two objectives: (1) to find associations between mammographic MCs and tumor pathology, and (2) to compare the diagnostic value of mammograms and breast biopsies in identifying malignant MCs. Breast cancer is the most common cancer in females over the age of 20. The advent of mammographic screening has provided us with the ability to detect potentially fatal tumors at a non-palpable stage, but it has created the platform to study the natural history of breast cancer in its early stages of development [2]. One of the detectable mammographic anomalies, and often the earliest signs of a malignant breast disease, are tiny deposits of calcium in the breast soft tissue, called microcalcifications (MCs) [3]. Active efforts have been made by radiologists to identify MCs in mammograms (Figure 1b), making them one of the most important diagnostic markers of breast lesions [5]
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