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Microcalcifications in 1657 Patients with Pure Ductal Carcinoma in Situ of the Breast: Correlation with Clinical, Histopathologic, Biologic Features, and Local Recurrence

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

This study was designed to determine the relationship of microcalcification morphology and distribution with clinical, histopathologic, biologic features, and local recurrence (LR) in patients with pure ductal carcinoma in situ (DCIS) of the breast.

Methods

All patients with pure DCIS who underwent preoperative mammography at our institution from 1996 through 2009 were identified. Mammographic findings were classified according to the ACR BI-RADS lexicon. Associations between mammographic findings and clinical, histopathologic, biologic characteristics, and LR were analyzed. Statistical inference used multiple logistic regression and Cox proportional hazards regression adjusted for age and confounding due to bias from nonrandomized selection of radiation therapy.

Results

We identified 1657 patients with microcalcifications visualized on mammography. The mean age at diagnosis was 55 years (SD, 11). The mean follow-up was 7 years (range 1–16). Ipsilateral LR was 4 % in segmentectomy (987) and 1.5 % in mastectomy (670) patients. Increased LR risk was seen in patients with dense breast tissue (p < 0.05) and larger DCIS size (p < 0.01). Radiation therapy was associated with a 2.8-fold decrease in the LR risk. Fine linear (branching) microcalcifications were associated with 5.2-fold increase in LR. Extremely dense breast tissue was associated with positive/close margins (p = 0.04) and multicentricity (p < 0.01). Younger women were more likely to have extremely dense breast tissue (p < 0.0001), multicentric disease (p < 0.0004), and undergo mastectomy (p < 0.0001).

Conclusions

Dense breast tissue, large DCIS size, and fine linear (branching) microcalcifications were associated with increased LR, yet overall LR rates remained low. Extremely dense breast tissue was a risk factor for multicentricity and positive margins in DCIS.

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Acknowledgments

Supported by the NIH/NCI under Award Number P30CA016672 and used the Biostatistics Resource Group from the Department of Biostatistics. The authors thank Stephanie Deming for assistance in editing of this manuscript.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Unit 1473, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Gaiane M. Rauch MD, PhD

  2. Department of Biostatistics, Unit 1411, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Brian P. Hobbs PhD & Patricia S. Fox MS

  3. Department of Surgical Oncology, Unit 1434, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Henry M. Kuerer MD, PhD & Abigail S. Caudle MD

  4. Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Marion E. Scoggins MD & Beatriz E. Adrada MD

  5. Department of Diagnostic Imaging, Unit 1476, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Ana P. Benveniste MD & Young Mi Park MD

  6. Department of Radiation Oncology, Unit 1202, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Benjamin D. Smith MD

  7. Department of Pathology Administration, Unit 0053, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Savitri Krishnamurthy MD

  8. Department of Diagnostic Radiology, Unit 1459, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Wei T. Yang MD

Authors
  1. Gaiane M. Rauch MD, PhD
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  2. Brian P. Hobbs PhD
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Correspondence to Gaiane M. Rauch MD, PhD.

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Rauch, G.M., Hobbs, B.P., Kuerer, H.M. et al. Microcalcifications in 1657 Patients with Pure Ductal Carcinoma in Situ of the Breast: Correlation with Clinical, Histopathologic, Biologic Features, and Local Recurrence. Ann Surg Oncol 23, 482–489 (2016). https://doi.org/10.1245/s10434-015-4876-6

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  • DOI: https://doi.org/10.1245/s10434-015-4876-6

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