Gaiane M. Rauch MD, PhD, Presenter: Nothing to Disclose

Brian Hobbs PhD, Abstract Co-Author: Nothing to Disclose

Henry M. Kuerer MD, Abstract Co-Author: Nothing to Disclose

Marion Elizabeth Scoggins MD, Abstract Co-Author: Nothing to Disclose

Sara Lari, Abstract Co-Author: Nothing to Disclose

Wei Tse Yang MD, Abstract Co-Author: Nothing to Disclose

Ana Paula Benveniste MD, Abstract Co-Author: Nothing to Disclose

Young Mi Park MD, PhD, Abstract Co-Author: Nothing to Disclose

Beatriz E. Adrada MD, Abstract Co-Author: Nothing to Disclose

Patricia Sue Fox MS, Abstract Co-Author: Nothing to Disclose

Savitri Krishnamurthy MD, Abstract Co-Author: Nothing to Disclose

Analyze microcalcifications (MC) on mammography (M) in patients with pure ductal carcinoma in situ (DCIS) by nuclear grade (G), comedonecrosis (CN), estrogen receptor (ER) status, patient age and surgical outcome.

An institutional review board approved retrospective single institution database search was performed from January 1, 1996 to July 31, 2009 of patients with pure DCIS who underwent preoperative M. All M and, when available, ultrasound (US) images were reviewed according to the ACR BIRADS® lexicon. Imaging findings were analyzed in respect to clinical, histopathologic, and biologic characteristics. Statistical analyses used multiple logistic regression with model selection via AIC or Pearson’s chi-squared test for marginal homogeneity or linear dependence.

There were 1911 patients with pure DCIS. Patients with negative M (n=98) and noncalcified lesions (n=155) were excluded, 1658 patients were included in final analysis. M was performed in all patients; US in 506 (31%) patients. Mean age at diagnosis was 55 years (SD, 11.0). G3 lesions were associated with fine linear morphology and segmental distribution of MC (p<0.05), larger in size on M (p<0.05), and more visible on US (p<0.005) than G 1/2 lesions. CN was associated with MC that had linear or segmental distribution (p<0.05), were large in size (p<0.005) on M, and visible on US (p<0.02). Masslike appearance of MC on US decreased odds of CN (p<0.05). Fine linear and fine pleomorphic MC morphology was associated with segmental distribution (p<0.0001. ER (-) lesions were more visible on US (p=0.002), and associated with G3 and CN . Dense breasts were associated with ER (-) lesions with CN, and with close surgical margins (p<0.05). Multicentricity was associated with US visibility (p<0.02), close surgical margins (p<0.01), and dense parenchyma (p<0.02). Pathologic size was associated with M and US size (p<0.0001) and decreased with patients age (p<0.005).

G3 DCIS and CN are associated with fine linear MC, segmental distribution, large size, ER (-) lesions, and visibility on US. Dense breasts are associated with multicentricity and close surgical margins.

Patients with dense breasts should be carefully evaluated for multicentricity and the possibility of close surgical margins, and might benefit from supplemental imaging.

Rauch, G, Hobbs, B, Kuerer, H, Scoggins, M, Lari, S, Yang, W, Benveniste, A, Park, Y, Adrada, B, Fox, P, Krishnamurthy, S, Microcalcifications in 1,658 Patients with Pure Ductal Carcinoma in Situ of the Breast: Imaging Findings with Clinical, Histopathologic and Biologic Correlation.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13020375.html