Kuzmiak Cherie M, Dancel Ria, Pisano Etta, Zeng Donglin, Cole Elodia, Koomen Marcia A, McLelland Robert
Department of Radiology, University of North Carolina at Chapel Hill, NC 27599, USA.
Acad Radiol. 2006 May;13(5):621-9. doi: 10.1016/j.acra.2006.01.042.
Breast calcifications seen on mammography may be associated with benign conditions or malignancies. Accurate characterization of these calcifications is crucial to providing optimal care that may spare women unnecessary biopsies and appropriately allow interval mammography. The purpose of this study is to determine if consensus characterization of calcifications by two breast imaging experts using standardized criteria can establish that follow-up is a safe option.
For this retrospective study, our breast imaging database was reviewed and the cases imaged between the years 1999 and 2001 were used to identify patients with calcifications who were recommended for a six-month follow-up or biopsy. All cases had been prospectively assessed by at least two expert breast imagers using standardized features to assess the findings before a recommendation for follow-up or a biopsy was made. A retrospective chart review examining the radiology reports was done to determine the percentage of women from each of the two groups who developed malignancies.
Of 744 patients who had mammographically identified clusters of calcifications, 490 clusters (409 single and 81 multiple) were diagnosed as probably-benign, and a short-interval 6-month follow-up was recommended. Of these calcifications followed for three years, only two (0.5%) of the single clusters proved to be malignant, and malignancy was diagnosed at the 12-month follow-up examination. In both cases, the women were diagnosed with ductal carcinoma in situ (DCIS). Of 254 clusters recommended for biopsy, 242 (215 single and 27 multiple) underwent biopsy. A total of 70 cancers were diagnosed: 54 (77.1%) were DCIS and 16 (22.9%) were primary invasive mammary carcinoma (10 cases of invasive ductal carcinoma, 3 cases of invasive lobular carcinoma, 2 cases of invasive ductal carcinoma with DCIS, and one case of invasive mucinous carcinoma with DCIS). Twenty-nine percent of women who had a biopsy performed had calcifications associated with malignancy. In contrast, in the women whose calcifications were followed by mammography, only 0.5% went on to develop malignancies.
Consensus review of calcifications by two breast imagers using standardized criteria is a safe follow-up option.
乳腺钼靶检查中发现的乳腺钙化可能与良性病变或恶性肿瘤相关。准确鉴别这些钙化对于提供最佳治疗至关重要，这可以避免女性不必要的活检，并合理安排定期乳腺钼靶检查。本研究的目的是确定两名乳腺影像专家使用标准化标准对钙化进行的共识性鉴别是否能确定随访是一种安全的选择。
对于这项回顾性研究，我们查阅了乳腺影像数据库，并使用1999年至2001年间成像的病例来识别被建议进行六个月随访或活检的钙化患者。所有病例在被建议进行随访或活检之前，均由至少两名专家乳腺影像医师使用标准化特征对检查结果进行前瞻性评估。通过回顾放射学报告进行回顾性病历审查，以确定两组中各有多少女性发生了恶性肿瘤。
在744例乳腺钼靶检查发现钙化簇的患者中，490个簇（409个单发和81个多发）被诊断为可能为良性，并建议进行短期6个月随访。在对这些钙化进行三年随访的过程中，只有两个单发簇（0.5%）被证明是恶性的，且在12个月的随访检查中被诊断为恶性。在这两个病例中，两名女性均被诊断为导管原位癌（DCIS）。在254个被建议进行活检的簇中，242个（215个单发和27个多发）接受了活检。共诊断出70例癌症：54例（77.1%）为DCIS，16例（22.9%）为原发性浸润性乳腺癌（10例浸润性导管癌，3例浸润性小叶癌，2例伴有DCIS的浸润性导管癌，1例伴有DCIS的浸润性黏液癌）。接受活检的女性中有29%的钙化与恶性肿瘤相关。相比之下，在通过乳腺钼靶检查对钙化进行随访的女性中，只有0.5%发展为恶性肿瘤。
两名乳腺影像医师使用标准化标准对钙化进行共识性审查是一种安全的随访选择。
