Kikuchi Mari, Tsunoda-Shimizu Hiroko, Kawasaki Tomonorii, Suzuki Koyu, Nakamura Seigo, Yagata Hiroshi, Tsugawa Koichiro, Takahashi Osamu
Department of Radiology, St.Luke's International Hospital, Tokyo, Japan.
Breast Cancer. 2007;14(3):285-91. doi: 10.2325/jbcs.14.285.
Since microcalcifications classified as category 3 on mammography include not only malignant lesions but also benign lesions, it is difficult to decide whether stereotactic vacuum-assisted breast biopsy (Mammotome(R), MMT) should be performed or the patient should merely be follows. The purpose of this study is to adequately diagnose microcalcifications classified as category 3 and to formulate a correct clinical policy. In addition, we examined the characteristics of the calcifications.
This study included 51 patients who underwent MMT from July 2003 to October 2004. All the cases were evaluated as category 3, and no abnormal findings were detected on ultrasonography. We classified the pattern of calcifications based on three aspects: 1. density and size, 2. pleomorphic appearance 3. number of calcifications per square centimeter.
Of the 51 patients, 14 were histologically diagnosed with ductal carcinoma in situ (DCIS). Heterogeneity in the density and size were observed in 9 of 14 patients (64.3%). The calcifications had a pleomorphic appearance in 6 of 14 patients (42.9%). A large number of calcifications (20/cm(2)) were observed in 8 of 14 patients (57.1%). Better examination characteristics were obtained with heterogeneity in density and size (AUC=0.72 95%C.I: 0.56-0.89) compared with pleomorphic appearance and the number of calcifications per square centimeter. The potential for malignancy was an average of 6 times higher for calcifications with heterogeneity in density and size compared to that for calcifications which were homogeneous in these aspects.
Attention should be paid to prevent unnecessary mammotome procedures. Heterogeneity in the density and size of calcifications is a reliable criterion for clinical decision-making.
由于乳腺钼靶检查中分类为3类的微钙化不仅包括恶性病变，还包括良性病变，因此很难决定是否应进行立体定位真空辅助乳腺活检（Mammotome®，MMT），还是仅对患者进行随访。本研究的目的是对分类为3类的微钙化进行充分诊断，并制定正确的临床策略。此外，我们还研究了钙化的特征。
本研究纳入了2003年7月至2004年10月期间接受MMT的51例患者。所有病例均评估为3类，超声检查未发现异常。我们从三个方面对钙化模式进行分类：1.密度和大小；2.形态；3.每平方厘米钙化数量。
51例患者中，14例经组织学诊断为导管原位癌（DCIS）。14例患者中有9例（64.3%）观察到密度和大小的异质性。14例患者中有6例（42.9%）钙化具有形态。14例患者中有8例（57.1%）观察到大量钙化（20/平方厘米）。与形态和每平方厘米钙化数量相比，密度和大小的异质性具有更好的检查特征（AUC = 0.72，95%CI：0.56 - 0.89）。密度和大小具有异质性的钙化的恶性潜能平均比这些方面均匀的钙化高6倍。
应注意避免不必要的Mammotome手术。钙化密度和大小的异质性是临床决策的可靠标准。
