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Mikrokalkdiagnostik an minimal-invasiven Biopsien im Mammographie-Screening

Ergebnisse aus der Prävalenzphase

Diagnostics of microcalcifications from minimally invasive biopsies in mammography screening

Results from the prevalence phase

  • Schwerpunkt: Mammapathologie
  • Published:
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Zusammenfassung

Hintergrund

Im Rahmen des Mammographie-Screenings nach EU-Leitlinien wird bei bis zu 3% der Teilnehmerinnen eine Biopsie durchgeführt. Ziel der Untersuchung war der Vergleich des Befundspektrums der histopathologischen Ergebnisse der im Screening durchgeführten minimal-invasiven Biopsien (MIB) mit Mikrokalk im Vergleich zu MIB ohne Mikrokalk.

Material und Methoden

Analyse der prospektiv erfassten histologischen Befundkomponenten der von Juli 2006 bis Juni 2007 durchgeführten MIB anhand der Brust-Screening-Pathologie-Datenbank am Referenzzentrum Münster.

Ergebnisse

4326 MIB wurden untersucht. 2161 MIB ergaben benigne (B1 bis B3) und 2165 maligne (B4 bis B5) Ergebnisse mit einer Gesamtmalignitätsrate von 50,04%. 1809 MIB trugen Mikrokalk und 2517 waren frei von Mikrokalk. Die histologischen Befunde und die Verteilung der B-Kategorien der MIB mit und ohne Mikrokalknachweis divergierten: Der Anteil der B2-Befunde betrug 44,5% vs. 24,2%, die B3-Rate 18,2% vs. 5,5% und die Malignitätsrate 36,8% vs. 59,5%. 83,3% der duktalen Carcinoma in situ (DCIS) wurde in mikrokalkhaltigen MIB gefunden.

Schlussfolgerung

Mikrokalkhaltige MIB bieten im Vergleich zu MIB ohne Mikrokalk ein komplett anderes Diagnosespektrum, insbesondere mit großem B3-Anteil. Bei niedrigerer Malignitätsrate werden an mikrokalkhaltigen MIB bei weitem die meisten DCIS diagnostiziert.

Abstract

Background

In mammography screening programmes carried out according to European guidelines, minimally invasive biopsies (MIB) are performed on up to 3% of participants. The aim of this study was to analyse the spectrum of histopathological findings including B categories in MIBs with microcalcifications compared to MIBs without microcalcifications.

Material and methods

Prospectively collected histological findings of MIBs taken during the period July 2006 to June 2007 were analysed using the Breast Screening Pathology Database of the Reference Centre in Münster.

Results

Of the 4,326 MIBs investigated, 2,161 were benign (B1-B3) whereas 2,165 were malignant (B4-B5) resulting in an overall malignancy rate of 50.04%. Of the MIBs 1,809 contained microcalcifications and 2,517 did not. Cases with microcalcifications showed a different distribution of B categories: B2 was found in 44.5% versus 24.2%, B3 in 18.2% versus 5.5% and the malignancy rate of cases with microcalcifications was 36.8% versus 59.5%. Of all cases of ductal carcinoma in situ (DCIS) detected in the screening programme, 83.35% were diagnosed in MIBs containing microcalcifications.

Conclusions

MIBs containing microcalcifications showed a different spectrum of diagnoses, especially higher rates of B3 lesions. Even though MIBs without microcalcifications showed a higher overall malignancy rate, most cases of DCIS were diagnosed in MIB containing microcalcifications.

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Abbreviations

AEPDT:

Atypische Epithelproliferationen vom duktalen Typ

BI-RADS:

„Breast Imaging Reporting and Data System“

DCIS:

Duktales Carcinoma in situ

FEA:

Flache epitheliale Atypie

LN:

Lobuläre Neoplasie

MIB:

Minimal-invasive Biopsie

UICC:

„Union Internationale Contre le Cancer“

VAB:

Vakuumassistierte Biopsie

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Danksagung

Wir danken den nachfolgend aufgeführten Kollegen, die Daten für das Mammographie-Screening zur Verfügung gestellt haben:

Dr. med. Michael Anton, Minden; PD Dr. med. Georg Arnold, Essen; Dr. med. Jörg-Michael Pahnke, Essen; Dr. med. Josiane Bédrossian-Pfingsten, Remscheid; Dr. med. Andrea Christians, Remscheid; Dr. med. Wilfried, Belder, Gütersloh; Dr. med. Michael Leichsenring, Gütersloh; PD Dr. med. Ralf Hildenbrand, Bonn; Dr. med. Magdolna Bollmann, Bonn; Prof. Dr. med. Reinhard Bollmann, Bonn; Dr. med. Henry Budihardjo-Welim, Hemer; Dr. med. Klaus Dumke, Bielefeld; Prof. Dr. med. Gösta Fischer, Wilhelmshaven; Dr. med. Harald Schulz, Wilhelmshaven; Prof. Dr. med. Johannes Friemann, Lüdenscheid; Prof. Dr. med. J.M. Gokel, Krefeld; Dr. med. Viktor Groß, Siegen; Dr. med. Bernd Hinrichs, Köln; Prof. Dr. med. Ruth Knüchel-Clarke, Aachen; Dr. med. Elisabeth Breuer, Aachen; Prof. Dr. med. Rainer Krech, Osnabrück; Dr. med. Thomas Christians, Osnabrück; Dr. med. Andreas Thiel, Duisburg; Dr. med. Ulrich Lang, Herford; Dr. med. Helke Antje Logemann, Herford; Dr. med. Claus Langwieder, Dortmund; Dr. med. August Dykgers, Dortmund; Herr Thomasz Zienkiewicz, Witten; Dr. med. Jens-Uwe Lawerenz, Witten; Prof. Dr. med. Johann Lorenzen, Dortmund; Dr. med. Rolf Rüdiger Meliß, Hamburg; Dr. med. Sylvia Brockmöller, Hamburg; Prof. Dr. med. Axel Niendorf, Hamburg; Dr. med. Wolf-Peter Oellig, Mülheim; Prof. Dr. med. Helmut Ostertag, Hannover; Dr. med. Enrico Pelz, Viersen; Dr. med. Reinhard Spanel, Viersen; Prof. Dr. med. Stathis Philippou, Bochum; Dr. (B.) Peter De Vos, Bielefeld; Dr. (B.) Dr. med. Friederike Poche-De Vos, Bielefeld; Prof. Dr. med. Ute Raute-Kreinsen, Bielefeld; Prof. Dr. med. Klaus Richter, Hannover; PD Dr. med. Herbert Radner, Hannover; PD Dr. med. Matthias Krams, Hannover; Dr. med. Beate Richter, Hannover; Dr. med. Eckehard Kupsch, Hannover; Dr. med. Hartwig Schreiber, Hannover; Dr. med. Markus Ruwe, Hagen; Prof. Dr. med. Werner Schlake, Gelsenkirchen; Prof. Dr. med. Ulrich Schmidt, Münster; Prof. Dr. med. Christian Witting, Münster; PD Dr. med. Hans-Udo Kasper, Münster; PD Dr. med. Peter W. Schmiegelow, Solingen; PD Dr. med. Rolf Schnabel, Essen-Steele; Dr. med. Wolfram Andreas Beutler, Bocholt; Dr. med. Robin Sen Gupta, Bocholt; Dr. med. Ulf Stachetzki, Aurich; Dr. med. Jörg Woziwodzki, Aurich; Dr. med. Reinhard Golz, Wuppertal; Prof. Dr. med. Stephan Störkel, Wuppertal; Dr. med. Sylke Vornhusen, Kleve; Dr. med. Thomas Sudermann, Kleve; Prof. Dr. med. Hans-Joachim Terpe, Leverkusen; Frau Barbara Kirch, Neuss; Dr. med. Ingo Theuerkauf, Neuss; Prof. Dr. med. Horst Bürger, Paderborn; Dr. med. Wolfgang Voß, Paderborn; Prof. Dr. med. Walter Wierich, Recklinghausen; Prof. Dr. med. Helmut K. Wolf, Detmold; Dr. med. Olaf Kedziora, Detmold.

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Authors and Affiliations

  1. Brust-Screening-Pathologie Gerhard Domagk-Institut für Pathologie, Universitätsklinikum Münster, Domagkstr 17, 48149, Münster, Deutschland

    D. Hungermann, E. Korsching, W. Böcker &  T. Decker

  2. Referenzzentrum Mammographie, Institut für Klinische Radiologie, Universitätsklinikum Münster, Münster, Deutschland

    S. Weigel & W. Heindel

Authors
  1. D. Hungermann
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  2. S. Weigel
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  3. E. Korsching
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  4. W. Heindel
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  5. W. Böcker
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  6. T. Decker
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Correspondence to T. Decker.

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Hungermann, D., Weigel, S., Korsching, E. et al. Mikrokalkdiagnostik an minimal-invasiven Biopsien im Mammographie-Screening. Pathologe 30, 31–35 (2009). https://doi.org/10.1007/s00292-008-1100-5

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  • DOI: https://doi.org/10.1007/s00292-008-1100-5

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