Abstract
ObjectiveTo evaluate suspicious amorphous calcifications diagnosed on full-field digital mammography (FFDM) and establish correlations with histopathology findings.Materials and MethodsThis was a retrospective study of 78 suspicious amorphous calcifications (all classified as BI-RADS® 4) detected on FFDM. Vacuum-assisted breast biopsy (VABB) was performed. The histopathological classification of VABB core samples was as follows: pB2 (benign); pB3 (uncertain malignant potential); pB4 (suspicion of malignancy); and pB5 (malignant). Treatment was recommended for pB5 lesions. To rule out malignancy, surgical excision was recommended for pB3 and pB4 lesions. Patients not submitted to surgery were followed for at least 6 months.ResultsAmong the 78 amorphous calcifications evaluated, the histopathological analysis indicated that 8 (10.3%) were malignant/suspicious (6 classified as pB5 and 2 classified as pB4) and 36 (46.2%) were benign (classified as pB2). The remaining 34 lesions (43.6%) were classified as pB3: 33.3% were precursor lesions (atypical ductal hyperplasia, lobular neoplasia, or flat epithelial atypia) and 10.3% were high-risk lesions. For the pB3 lesions, the underestimation rate was zero.ConclusionThe diagnosis of precursor lesions (excluding atypical ductal hyperplasia, which can be pB4 depending on the severity and extent of the lesion) should not necessarily be considered indicative of underestimation of malignancy. Suspicious amorphous calcifications correlated more often with precursor lesions than with malignant lesions, at a ratio of 3:1.
Highlights
Breast cancer is the leading cancer in women, in developed and developing countries[1]
The morphologic characteristics of the suspicious amorphous microcalcifications were as follows: solely amorphous, in 53 (68.0%) of the 78 cases, and punctate microcalcifications accompanied by amorphous microcalcifications, in 25 (32.1%)
The detection rate in our study was high in comparison with those reported in previous studies, which is probably due to the fact that our analysis was based solely on full-field digital mammography (FFDM), whereas those of other studies have been either based solely on conventional mammography or based on a mixture of breast imaging techniques[15,16,19,20,21], as well as because our study was conducted during the first year after the introduction of the digital technique into the breast cancer screening protocol of the clinics in question[22]
Summary
Breast cancer is the leading cancer in women, in developed and developing countries[1]. The use of mammography enables early detection of breast cancer and leads to a reduction in mortality from the disease, as demonstrated in studies performed with conventional screen-film mammography[2,3]. Ferreira VCCS et al / Suspicious amorphous microcalcifications and histopathology. The introduction of full-field digital mammography (FFDM) for screening has yielded enhanced diagnostic benefits. Comparative studies of conventional mammography and FFDM have shown the latter to be superior in terms of the identification of microcalcifications, increasing detection rates for ductal carcinoma in situ (DCIS) and invasive carcinoma[4,5,6]
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