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Mammographic Predictors of the Presence and Size of Invasive Carcinomas Associated With Malignant Microcalcification Lesions Without a Mass

¹ Department of Diagnostic Imaging, Roswell Park Cancer Institute, School of Medicine and Biomedical Sciences, Elm and Carlton Sts., SUNY at Buffalo, NY 14263.
² Department of Pathology, Roswell Park Cancer Institute, School of Medicine and Biomedical Sciences, SUNY at Buffalo, NY 14263.
³ Department of Surgery, Roswell Park Cancer Institute, School of Medicine and Biomedical Sciences, SUNY at Buffalo, NY 14263.
⁴ Department of Medicine, Roswell Park Cancer Institute, School of Medicine and Biomedical Sciences, SUNY at Buffalo, NY 14263.

OBJECTIVE. Our objective was to determine the degree with which mammographic features predict the presence and size of invasive carcinomas associated with malignant mammographic microcalcification lesions without a mass.

MATERIALS AND METHODS. Mammographic features were correlated with pathologic features in 304 consecutive breast carcinomas manifested by mammographic calcifications only in a prospective evaluation.

RESULTS. Mammographic calcifications associated with breast carcinoma had the final pathologic diagnoses of pure ductal carcinoma in situ (DCIS) in 65% of patients, DCIS with a focus of invasion in 32%, and invasive carcinoma only in 4%. Invasive foci were more likely associated with mammographic calcification size of 11 mm and greater (40%, 77/194) compared with 1–10 mm (26%, 29/110; p = 0.019). Invasive foci were also more likely associated with linear calcifications (44%, 55/126) compared with granular calcifications (29%, 51/178; p = 0.007). The frequency of invasion did not increase with calcification extents greater than 10 mm. The frequency of invasion ranged from 22% for less than or equal to 5-mm granular calcifications to 45% for linear calcifications of 11 mm and greater. Only 11% of cancers characterized by fine granular calcifications were associated with invasion as compared with 32% of those with coarse and mixed granular calcifications (p = 0.002).

CONCLUSION. Mammographic calcification features of malignant lesions cannot predict the absence of invasion with greater than 90% predictive value or predict the presence of invasion with greater than 45% predictive value. Increased extent of calcifications greater than 10 mm was not associated with greater likelihood of invasion.

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