Histological correlation of microcalcifications in breast biopsy specimens

Hypothesis: Nonpalpable malignant-appearing microcalcifications discovered by mammography geographically target the location of the most important abn ormality within the breast. Core needle or open biopsy of these microcalcif ications will sample or remove underlying proliferative or invasive disease . Design: A prospective database of 403 consecutive patients undergoing breas t biopsy for nonpalpable abnormalities from July 1, 1994, to December 31, 1 996, was reviewed to identify biopsies done for indeterminate microcalcific ations. Specimens showing atypical hyperplasia, carcinoma in situ, or invas ive carcinoma were identified and reviewed by 1 pathologist. The position o f microcalcifications larger than 100 mu m were recorded in reference to th e histological findings. Setting: A 450-bed referral community teaching hospital in rural Wisconsin. Patients: Indeterminant microcalcifications were identified on mammograms i n 167 (41.4%) of 403 patients. Sixty-one (36.5%) of 167 biopsy specimens co ntained atypical hyperplasia, carcinoma in situ, or invasive carcinoma, and the slides of these 61 initial breast biopsy specimens were reviewed. Main Outcome Measures: Relationship of breast histopathological findings to microcalcifications. Results: In these 61 specimens, 82 areas of atypical hyperplasia, carcinoma in situ, or invasive carcinoma were noted. The microcalcifications correla ted with these areas in 43 (52%) of 82 areas on slide review and were prese nt in the most important abnormality in 33 (54%) of 61 biopsy specimens. Conclusions: Indeterminant microcalcifications identified by mammography ma y not target the exact location of underlying breast disease. Careful evalu ation of the entire biopsy specimen and close follow-up of patients with be nign pathologic findings are recommended.