Sean D. Raj MD, Presenter: Nothing to Disclose

Emily Lorraine Sedgwick MD, Abstract Co-Author: Nothing to Disclose

Frederick Joseph Severs MD, MS, Abstract Co-Author: Nothing to Disclose

Karla A. Sepulveda MD, Abstract Co-Author: Nothing to Disclose

Pathology from biopsy of a large area of segmental calcifications on mammography can have direct impact on surgical management. Although dependent on breast size, cancer spanning greater than 5 cm is usually treated with mastectomy and cancer less than 5 cm is managed with lumpectomy. There is insufficient data on whether a single central biopsy of calcifications that assumes homogeneity of disease in the imaging abnormality is adequate to establish need for mastectomy, or if pathologic proven cancer in the anterior and posterior components defining extent of disease is required. This study aims to evaluate concordance rates of paired biopsies of suspicious segmental mammographic calcifications.

From a 5 year review of our imaging database, 66 subjects with BI-RADS® 4 or 5 segmental calcifications on mammography that underwent anterior and posterior stereotactic biopsies were identified. The paired biopsy results were analyzed for concordance in benign, high risk and malignant pathology.  

Of the 66 cases, there was strong agreement (Kappa=0.88, p<0.001) in anterior and posterior pairs in benign, high-risk and malignant findings with 92% concordance (61/66 cases; 95% CI=83-97%). In 3 cases of discordance involving high risk (ADH) and malignancy (DCIS), management did not change, as surgery was required at both sites. In 2 cases with discordant benign and high risk (few foci of ALH) management did not change as observation was performed rather than surgery.

The absence of data on pathologic concordance in anterior and posterior aspects of segmental calcifications has led to a varied clinical approach to biopsy. In our study, the sampling of 2 components of segmental calcifications spanning more than 5 cm on mammography yielded high concordance, and there was no change in surgical management in the discordant results. Although further prospective investigation is warranted, this data suggests that a single central biopsy of suspicious segmental calcifications would be adequate for diagnosis and representative of the whole imaging abnormality. This approach reduces potentially unnecessary biopsies, associated morbidity and health care costs.

Greater than 90% concordance of pathology in biopsies of anterior and posterior aspects of segmental calcifications suggests a single central biopsy would be adequate to establish diagnosis of a large segmental mammographic abnormality.

Raj, S, Sedgwick, E, Severs, F, Sepulveda, K, Stereotactic Biopsy of Segmental Breast Calcifications: Is Sampling of Anterior and Posterior Components Necessary?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045618.html