WASHINGTONA new study indicates that amorphous breast
calcifications, unless clearly benign, should be considered
suspicious lesions and should be stereotactically biopsied, said
Wendie Berg, MD, PhD, associate professor of radiology and director
of the Division of Breast Imaging, University of Maryland.
Improved imaging technology is leading to increased detection of
amorphous calcifications (which appear subtle and powdery on film),
but consensus has been lacking about how dangerous they are, Dr. Berg
said at the 100th annual meeting of the American Roentgen Ray Society (ARRS).
Although evidence indicates that about 2% of these lesions might be
malignant, researchers have suspected that the proportion is actually
much higher, Dr. Berg said. Some clinicians have biopsied the
calcifications and some have monitored them without biopsy, resulting
in delayed diagnosis for some malignancies, she said.
It never has been really clear, she said. Rather
than sit on the fence, we wanted to determine the outcomes of
patients with these lesions.
From July 1995 through March 2000, Dr. Berg and her colleagues
recommended biopsy for all clustered amorphous calcifications seen
mammographically that were not clearly stable for at least 5 years.
Over the study period, 150 lesions in 132 women were characterized as
amorphous calcifications and were biopsied, Dr. Berg said. Of the
biopsies, 113 were performed stereotactically.
Overall, of the 150 lesions, 30 proved cancerousa malignancy
rate of 20%. Twenty-seven were ductal carcinoma in situ (DCIS), and
three were low-grade invasive and intraductal carcinoma.
Another 30 lesions were found to be high-risk abnormalities. These
included 21 atypical ductal hyperplasia, eight atypical lobular
hyperplasia, and one lobular carcinoma in situ.
Sixteen lesions biopsied stereotactically yielded atypical ductal
hyperplasia, a marker signifying a 10% to 20% chance of cancer
nearby. Of these, two proved to have DCIS.
Eight lesions biopsied stereotactically yielded atypical lobular
hyperplasia, signifying the possibility of cancer somewhere in the
breast, and one of these was indeed a marker for DCIS, Dr. Berg reported.
Such calcifications can be appropriately classified as
suspicious, she said. I think this is pretty clear
evidence we should be recommending biopsy for them. If you take care
of these things now, itll mean a lot less trouble down the road.
Dr. Bergs team also analyzed the lesions by family history. Of
96 lesions in patients with no known family history of breast cancer,
16 (17%) were malignant. Of 12 lesions in patients with a family
history, one (.08%) was malignant. These findings are significant,
she said, because radiologists may be more likely to biopsy patients
with a family history of the disease or other risk factors.