E. Saccomandi et al., BREAST-CANCER REVEALED BY CLUSTER OF MICR OCALCIFICATIONS WITHOUT PALPABLE MASS - PROGNOSIS AND TREATMENT, La Presse medicale, 24(28), 1995, pp. 1291-1295
Objectives: Routine screening mammography has greatly increased the nu
mber of breast cancers detected in the form of clumped microcalcificat
ions without a palpable tumour. Methods: From 1964 to 1989, 315 breast
cancers revealed by microcalcifications without contralateral cancer,
treated at the Institut Curie, Cancers were observed in 40% of the mi
crocalcifications excised. Treatment was conservative in 57.5% of case
s and mutilating in 42.5% of cases; these rates have changed only very
slightly with time. Histologically, 50% of the tumours were intraduct
al cancers, 25% were microinvasive, 24% were infiltrating and 1% were
lobular in situ carcinomas. The therapeutic indication can be defined
on the basis of the histological result of the initial tumour excision
, as the initial examination underestimated the lesions in only 5.6% o
f cases. Lymph node invasion was observed in 1.8% of intraductal cance
rs, 5.3% of microinvasive cancers and 14.8% of invasive cancers. Resul
ts: The overall survival was 99% at 5 years and 89.9% at 10 years. The
prognosis of invasive cancer was less favourable than that of intradu
ctal and microinvasive cancers (p = 0.03). Survival was not influenced
by the radical or conservative nature of treatment. The presence of l
ymph node invasion severely worsened the prognosis. The 5 year recurre
nce rate was 4.2% for intraductal, 4.6% for microinvasive and 6.1% for
invasive. The incomplete nature of the resection increased the local
recurrence rate: 11.9% at 5 years instead of 5%. Conclusion: Conservat
ive treatment of cancers revealed by microcalcifications without a pal
pable tumour therefore appears to be justified provided the lesion is
radiologically localized, with a histologically satisfactory resection
and in the absence of residual microcalcifications on postoperative m
ammography.