Giess C S, Keating D M, Osborne M P, Mester J, Rosenblatt R
Department of Radiology, The New York Presbyterian Hospital, Strang-Cornell Breast Center, 525 E. 68th St., New York, NY 10021, USA.
AJR Am J Roentgenol. 2000 Sep;175(3):789-93. doi: 10.2214/ajr.175.3.1750789.
The study purpose was to evaluate the rate of development and the rate of change for benign and malignant breast calcifications at the lumpectomy bed.
Retrospective review identified 53 new calcifications at the lumpectomy bed in patients with available mammograms and medical records. Breast Imaging Reporting and Data System (BI-RADS) categories were retrospectively assigned on the basis of initial prospective recommendation for yearly follow-up (category 2), 6-month follow-up (category 3), or biopsy (category 4 or 5). Outcomes were defined as benign for no recurrence at the lumpectomy bed on biopsy or follow-up and malignant if biopsy-proven at the lumpectomy bed.
The median rate of development after lumpectomy was 23 months (range, 2-174 months) for benign and 39 months (range, 15-112 months) for malignant calcifications. Fifteen (28%) of 53 calcifications were classified as BI-RADS category 3. Twelve (80%) of 15 were downgraded to BI-RADS category 2 at a median follow-up of 6.5 months (range, 6-16 months); none represented recurrent disease. Three (20%) of 15 were upgraded to BI-RADS category 4 at the 6-month follow-up, one despite stability (benign) and two for increasing pleomorphism (malignant). Nine (17%) of 53 calcifications were classified as BI-RADS category 4 or 5; six (67%) of the nine were malignant and three (33%) were benign at biopsy. Twenty-nine (55%) of 53 calcifications were classified as BI-RADS category 2, none representing recurrent disease.
Benign calcifications at the lumpectomy bed usually develop earlier than malignant calcifications, but the rate of development overlaps. Most calcifications initially placed in the probably benign category evolve quickly to more benign or more malignant morphology. Most calcifications heralding recurrence appear suspicious on first presentation.
本研究旨在评估保乳手术切缘处良性和恶性乳腺钙化的发生速率及变化速率。
通过回顾性研究，在有乳腺钼靶片和病历的患者中，确定了保乳手术切缘处的53处新钙化灶。根据最初前瞻性建议的每年随访（2类）、每6个月随访（3类）或活检（4类或5类），对乳腺影像报告和数据系统（BI-RADS）分类进行回顾性赋值。若活检或随访时保乳手术切缘无复发，则结果定义为良性；若保乳手术切缘经活检证实为恶性，则结果定义为恶性。
保乳手术后，良性钙化灶出现的中位时间为23个月（范围2 - 174个月），恶性钙化灶为39个月（范围15 - 112个月）。53处钙化灶中有15处（28%）被分类为BI-RADS 3类。15处中的12处（80%）在中位随访6.5个月（范围6 - 16个月）时降级为BI-RADS 2类；均无复发病例。15处中的3处（20%）在6个月随访时升级为BI-RADS 4类，1处尽管稳定（良性），2处因异形性增加（恶性）。53处钙化灶中有9处（17%）被分类为BI-RADS 4类或5类；9处中的6处（67%）活检时为恶性，3处（33%）为良性。53处钙化灶中有29处（55%）被分类为BI-RADS 2类，均无复发病例。
保乳手术切缘处的良性钙化通常比恶性钙化出现得早，但出现速率有重叠。大多数最初被归为可能良性类别的钙化灶会迅速演变为更良性或更恶性的形态。大多数预示复发的钙化灶首次出现时就表现可疑。
