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Suspicious breast calcifications undergoing stereotactic biopsy in women ages 70 and over: Breast cancer incidence by BI-RADS descriptors

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Abstract

Objectives

To determine the malignancy rate overall and for specific BI-RADS descriptors in women ≥70 years who undergo stereotactic biopsy for calcifications.

Methods

We retrospectively reviewed 14,577 consecutive mammogram reports in 6839 women ≥70 years to collect 231 stereotactic biopsies of calcifications in 215 women. Cases with missing images or histopathology and calcifications associated with masses, distortion, or asymmetries were excluded. Three breast radiologists determined BI-RADS descriptors by majority. Histology, hormone receptor status, and lymph node status were correlated with BI-RADS descriptors.

Results

There were 131 (57 %) benign, 22 (10 %) atypia/lobular carcinomas in situ, 55 (24 %) ductal carcinomas in situ (DCIS), and 23 (10 %) invasive diagnoses. Twenty-seven (51 %) DCIS cases were high-grade. Five (22 %) invasive cases were high-grade, two (9 %) were triple-negative, and three (12 %) were node-positive. Malignancy was found in 49 % (50/103) of fine pleomorphic, 50 % (14/28) of fine linear, 25 % (10/40) of amorphous, 20 % (3/15) of round, 3 % (1/36) of coarse heterogeneous, and 0 % (0/9) of dystrophic calcifications.

Conclusions

Among women ≥70 years that underwent stereotactic biopsy for calcifications only, we observed a high rate of malignancy. Additionally, coarse heterogeneous calcifications may warrant a probable benign designation.

Key Points

• Cancer rates of biopsied calcifications in women ≥70 years are high

• Radiologists should not dismiss suspicious calcifications in older women

• Coarse heterogeneous calcifications may warrant a probable benign designation

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Abbreviations

BI-RADS:

breast imaging reporting and data system

DCIS:

ductal carcinoma in situ

ER:

estrogen receptor

HER2:

human epidermal growth factor receptor 2

LCIS:

lobular carcinoma in situ

PR:

progesterone receptor

USPSTF:

United States Preventive Services Task Force

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Acknowledgments

The scientific guarantor of this publication is Lars Grimm. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, cross sectional study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Duke University Medical Center, Durham, NC, USA

    Lars J. Grimm, David Y. Johnson, Karen S. Johnson, Jay A. Baker, Mary Scott Soo & Sujata V. Ghate

  2. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    E. Shelley Hwang

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  1. Lars J. Grimm
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  2. David Y. Johnson
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  3. Karen S. Johnson
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Correspondence to Lars J. Grimm.

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Grimm, L.J., Johnson, D.Y., Johnson, K.S. et al. Suspicious breast calcifications undergoing stereotactic biopsy in women ages 70 and over: Breast cancer incidence by BI-RADS descriptors. Eur Radiol 27, 2275–2281 (2017). https://doi.org/10.1007/s00330-016-4617-7

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  • DOI: https://doi.org/10.1007/s00330-016-4617-7

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