MANAGEMENT OF MICROCALCIFICATIONS THAT DEVELOP AT THE LUMPECTOMY SITEAFTER BREAST-CONSERVING THERAPY

PURPOSE: To design a decision tree according to time from irradiation and site, morphology, and number of microcalcifications for the ration al treatment of patients with microcalcifications at the lumpectomy si te after breast-conserving therapy (BCT), to minimize performance of b iopsy. MATERIALS AND METHODS: From a database of 504 women selected to receive BCT, those developing probably benign microcalcifications wit hin 3 years of BCT received close follow-up with mammography. Patients developing fewer than four probably benign microcalcifications more t han 3 years after treatment were offered mammography or biopsy. If mic rocalcifications appeared malignant or patients developed four or more microcalcifications after 3 years, biopsy was performed. RESULTS: Twe nty-eight patients (29 breasts [5.7%]) developed microcalcifications c onfined to the lumpectomy site. Fifteen patients (15 breasts) develope d microcalcifications within 3 years of BCT and were followed up with mammography. Thirteen patients (14 breasts) developed microcalcificati ons confined to the lumpectomy site after more than 3 years. Among the latter group, microcalcifications appeared malignant in four breasts, and biopsy specimens revealed three recurrences. The remaining 10 bre asts were followed up with mammography. No patient undergoing mammogra phic follow-up without biopsy has had clinical evidence of local failu re throughout the follow-up period. CONCLUSION: Follow-up mammography is an option when benign-appearing microcalcifications develop at the lumpectomy site depending on time of appearance and number; it is the primary recommendation when these microcalcifications develop within 3 years after treatment.