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Calcifications Highly Suggestive of Malignancy

Comparison of Breast Biopsy Methods

¹ Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.
² Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.

View larger version (116K): [in a new window]   Fig. 1A. —54-year-old woman who underwent left lumpectomy, sentinel lymph node biopsy, and radiation therapy for infiltrating ductal carcinoma and ductal carcinoma in situ (DCIS) 2 years previously. Craniocaudal left mammogram shows linear and pleomorphic calcifications in linear distribution spanning 2.5 cm (arrows) anterior to clip at lumpectomy site.

View larger version (81K): [in a new window]   Fig. 1B. —54-year-old woman who underwent left lumpectomy, sentinel lymph node biopsy, and radiation therapy for infiltrating ductal carcinoma and ductal carcinoma in situ (DCIS) 2 years previously. Magnified (x3) radiograph of specimens obtained during stereotactic 11-gauge directional vacuum-assisted biopsy indicates calcifications have been retrieved.

View larger version (132K): [in a new window]   Fig. 1C. —54-year-old woman who underwent left lumpectomy, sentinel lymph node biopsy, and radiation therapy for infiltrating ductal carcinoma and ductal carcinoma in situ (DCIS) 2 years previously. Histologic analysis of material obtained at stereotactic biopsy reveals ductal carcinoma in situ. Note isolated necrotic cells (arrowheads) and calcification (arrows). No residual tumor was found at mastectomy. (H and E, x40)

View larger version (142K): [in a new window]   Fig. 2. —52-year-old asymptomatic woman. Mediolateral oblique right mammogram shows linear and pleomorphic calcifications in segmental distribution spanning at least 5.0 cm at maximal diameter. Stereotactic 11-gauge directional vacuum-assisted biopsy was performed of two sites (arrows); both sites yielded ductal carcinoma in situ, but superior site also yielded microinvasion. Patient had one-stage mastectomy and axillary lymph node dissection, yielding infiltrating ductal carcinoma (0.3 cm), extensive ductal carcinoma in situ, and lymph nodes negative for metastasis.

View larger version (131K): [in a new window]   Fig. 3A. —71-year-old asymptomatic woman. Mediolateral oblique right mammogram shows pleomorphic calcifications (arrows) in segmental distribution measuring 3 cm at maximal diameter.

View larger version (101K): [in a new window]   Fig. 3B. —71-year-old asymptomatic woman. Magnified radiograph of stereotactic biopsy specimens show calcifications. Histologic analysis yielded ductal carcinoma in situ (DCIS).

View larger version (124K): [in a new window]   Fig. 3C. —71-year-old asymptomatic woman. Mediolateral oblique right mammogram obtained on day of surgery shows bracketing wires placed to delineate anterior and posterior extent of calcifications during preoperative needle localization. Surgery revealed DCIS; surgical margins were free of tumor.

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