The value of postlumpectomy mammogram in the management of breast cancer patients presenting with suspiciouis microcalcifications

PURPOSE It is recommended that patients with breast cancer who present with mammogr aphically detected microcalcification should undergo postlumpectomy mammogr am with magnification views to ensure adequate removal of all clinically de monstrable disease. The value of postlumpectomy mammogram has not been adeq uately examined in the literature. This report aims to quantify the value o f such a study. MATERIALS AND METHODS Retrospective review identified 90 breast cancer patients referred to our d epartment between 1992 and 1997 who met all of the following criteria: (1) patients were considered for breast conserving management; (2) patients had suspicious microcalcifications on diagnostic mammograms; (3) the mammograp hic lesions were thought to be removed entirely on postexcision specimen ra diographs; (4) surgical excisions were thought to be adequate on the basis of a review of the histologic pathology reports; and (5) postlumpectomy mam mograms with magnification views were obtained. Fifty patients had invasive adenocarcinoma and 40 patients had ductal carcinoma in situ. The margins o f last resection were clear, close, or focally involved in 70, 13, and seve n patients, respectively. Patient records were reviewed to determine whethe r postlumpectomy mammograms demonstrated residual microcalcifications. RESULTS Sixteen patients (17%) were found to have residual microcalcifications on p ostlumpectomy mammograms. Twelve patients underwent either local re-excisio n (seven patients) or simple mastectomy (five patients). Re-excision was no t performed in four patients. Residual malignant cells were found in eight patients (67% of the re-excision group and 9% of the whole group). Six of t hese patients had their tumors initially resected with clear margins and th e remaining two patients had their tumors initially resected with close mar gins. CONCLUSIONS Postlumpectomy mammograms with magnification views detected residual clinic al disease in a significant proportion of patients. Our result supports the routine use of this test, even when satisfactory postexcision specimen rad iographs and adequate lumpectomy resection margins are obtained. This findi ng is particularly true for patients with ductal carcinoma in situ.