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

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

Wei Tse Yang MD, Abstract Co-Author: Researcher, Hologic, Inc

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

To analyze relationships between mammographic characteristics of microcalcifications (MC) and survival in patients with pure ductal carcinoma in situ (DCIS).

An IRB approved retrospective database search was performed from January 1996 to July 2009 of patients with pure DCIS who had preoperative mammography (M). All M were reviewed according to the ACR BIRADS® lexicon. Multiple Cox regression was used to evaluate the relative impact of MC morphology and distribution on survival while controlling for the effects of age, breast tissue density (BTD), adjuvant hormonal therapy (AHT), radiation therapy (XRT), and surgical margins. Stratified log-rank tests were used to investigate whether the effectiveness of XRT varied by MC morphology, distribution, or age.

Of 1911 patients with pure DCIS, 255 patients with negative M and noncalcified lesions were excluded, leaving 1656 patients for final analysis (mean age 55 years, SD 11.0). The lesion mean size was 2.9 cm (SD, 2.9). The median follow up was 7 years (range 1 - 15.9). There were 183 (11%) long-term events: death 78 (4%), contralateral breast cancer 66 (4%), locoregional recurrence 49 (2.5%), and distant metastasis 7(0.5%). Event rates increased with patient age (p<0.001), positive surgical margins (p<0.02) and decreased in patients with XRT (p<0.004). The data failed to show significant evidence that survival was impacted by MC morphology and BTD in multiple regression analysis. There was tendency to decreased survival for patients with linear/segmental distribution of DCIS MC (p=0.06). XRT was associated with improved survival among older (>55) patients (p<0.001), DCIS with amorphous and pleomorphic/heterogeneous morphology (p<0.05) and grouped distribution of MC (p<0.001). XRT didn’t improve survival for DCIS MC with fine linear/branching morphology (p=0.4) and regional/diffuse or linear/segmental distribution in stratified analysis.

When controlled for the effects of interventions MC morphology did not identify subgroups prognostic for survival. There is some evidence that MC distribution may be prognostic with diminished survival for linear/segmental patterns. XRT was associated with improved survival for subgroups of DCIS MC.

Both MC morphology and distribution may provide predictive markers for XRT with enhanced benefit for amorphous and heterogeneous/pleomorphic morphology and grouped distribution.

Rauch, G, Hobbs, B, Kuerer, H, Scoggins, M, Benveniste, A, Yang, W, Park, Y, Adrada, B, Fox, P, Krishnamurthy, S, Mammographic Features of Microcalcifications and Survival in Patients with Pure Ductal Carcinoma in Situ of the Breast: Population Based Retrospective Cohort Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009958.html