Department of Histopathology, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
Breast J. 2013 May-Jun;19(3):319-24. doi: 10.1111/tbj.12106. Epub 2013 Apr 18.
Mammographic calcification is an important radiologic feature of early breast carcinoma whose index of suspicion for malignancy may be reported by a five-tier R-category system. This study aims to describe the histologic diagnoses underlying screen-detected mammographic calcifications using both digital and screen-film mammography, and to correlate these findings with radiologic R-categories. Patients attending the Merrion Breast Screening Unit in Dublin between 2000 and 2011 were identified, who underwent needle-core biopsy for assessment of mammographic calcifications without associated mass or architectural distortion. Radiologic R-category was correlated with biopsy and excision histology reports. A total of 776 cases of calcification were identified, involving 769 individual patients. The radiologic R-categories were as follows: R3 513 (66.1%), R4 192 (24.7%), R5 71 (9.1%). The positive predictive values for malignancy were R3 32.6%, R4 69.8%, R5 95.8%. Several histologic features of DCIS were associated with R5 rather than R3 radiology: high nuclear grade, solid or cribriform architecture, necrosis, periductal inflammation or fibrosis, and associated microinvasive or invasive carcinoma. Mammographic lesions and histologic whole and invasive tumors increased in size from R3 to R5. Radiologic size of calcifications correlated with whole (but not invasive) tumor size, although it tended to underestimate it by several millimeters. Digital-detected calcifications were more likely than screen-film detected to be categorized as R3 and less likely R4 or R5, and there was no significant difference in positive predictive value between the two imaging techniques in any R-category. In conclusion, histologic features of DCIS, in particular those associated with high grade, are associated with R5 radiology. There is no significant difference in positive predictive value for malignancy in any R-category between digital and screen-film mammography.
乳腺钙化是早期乳腺癌的一个重要影像学特征，其恶性肿瘤的可疑指数可以通过 5 级 R 分类系统报告。本研究旨在描述数字和屏片乳腺摄影筛查发现的乳腺钙化的组织学诊断，并将这些发现与放射学 R 分类相关联。在 2000 年至 2011 年间，我们对都柏林 Merrion 乳腺筛查中心的患者进行了识别，这些患者因乳腺钙化而接受了针芯活检评估，且没有伴发肿块或结构扭曲。将放射学 R 分类与活检和切除组织学报告相关联。共发现 776 例钙化病例，涉及 769 名患者。放射学 R 分类如下：R3 513 例（66.1%），R4 192 例（24.7%），R5 71 例（9.1%）。恶性肿瘤的阳性预测值分别为 R3 32.6%，R4 69.8%，R5 95.8%。几种 DCIS 的组织学特征与 R5 而不是 R3 放射学相关：核高级别、实性或筛状结构、坏死、导管周围炎症或纤维化，以及伴发的微浸润或浸润性癌。乳腺 X 线摄影病变和组织学全瘤和浸润性肿瘤的大小从 R3 增加到 R5。放射学钙化大小与全瘤（而非浸润性肿瘤）大小相关，但通常低估几个毫米。与屏片摄影相比，数字摄影检测到的钙化更可能被归类为 R3，而不太可能被归类为 R4 或 R5，并且在任何 R 分类中，两种成像技术的阳性预测值都没有显著差异。总之，DCIS 的组织学特征，特别是与高级别相关的特征，与 R5 放射学相关。在任何 R 分类中，数字和屏片乳腺摄影的恶性肿瘤阳性预测值都没有显著差异。
