3-D HISTO-RADIOGRAPHIC COMPARISON OF SURGICAL CLEARANCES OF MICROCALCIFIED LESIONS IN BREAST LOCALIZATION BIOPSIES

There is controversy as to the value of the radiological or pathologic al estimation of surgical clearance of microcalcifying breast lesions. An important part of this issue has been addressed by coordinated thr ee-dimensional radiographic and histological examination of a prospect ive consecutive series of 40 benign and malignant mammographically det ected lesions in surgical breast biopsy specimens containing microcalc ifications, including 20 cases of ductal carcinoma in situ. The were r adiographed from four viewpoints by means of rotation in a radiolucent tetrahedral container. The planes of histological examination were th en chosen to correspond to the radiographic view showing the minimum s eparation of the edge of the specimen and the outermost microcalcifica tion. There was a close correlation (Spearman ranked) between the leas t tetrahedral radiographic distance and the corresponding histological distance separating the surgical margin of excision. There were, howe ver, incompatible Wilcoxon signed;ranking orders when comparing the le ast tetrahedral distance or the histological distance with all four si ngle radiographic views, including the conventional specimen radiograp hic view. Two-dimensional specimen mammography and standardized histol ogical examination are suboptimal and may thus have contributed to con fusion as to the value of determining adequate surgical excision of du ctal carcinoma in situ of the breast. Although labour-intensive, use o f four-view radiography and choice of the appropriate plane of histolo gical examination give a better correlation of the radiographic estima tes of surgical clearance with histology than single-view specimen rad iography and arbitrary histological sectioning. (C) 1997 by John Wiley & Sons, Ltd.