From the Department of Radiology, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15213 (H.C.O., W.A.B., S.S.C., S.S., M.A., M.L.Z.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (W.A.B., A.I.B., M.A., M.L.Z.); and Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa (A.I.B.).
Radiology. 2018 Sep;288(3):671-679. doi: 10.1148/radiol.2018172406. Epub 2018 Jun 19.
Purpose To determine rate of malignancy at stereotactic biopsy of amorphous calcifications with different distributions using current imaging, clinical, and histopathologic criteria. Materials and Methods From January 2009 to September 2013, this retrospective study reviewed a large set of stereotactic biopsies to identify amorphous calcifications and their clinical, imaging, and histopathologic characteristics. Calcification distribution was correlated with malignancy rate after adjusting for known risk factors using logistic regression. Results Of 1903 sequential biopsies, 546 (28.7%) were for amorphous calcifications. After excluding atypical lesions not excised and patients with more than one biopsy in the same year, 497 lesions from 494 women (median age, 52 years; age range, 30-81 years) remained. Fifty-two (10.5%; 95% confidence interval [CI]: 7.9, 13.5) lesions proved malignant, with 17 of 52 (42.7%) being invasive cancers (median, 0.3 cm; range, 0.1-1.3 cm) and all 17 of them being estrogen and progesterone receptor positive and node negative. Malignancy rates in a segmental (six of 21 [28.6%]), linear (eight of 32 [25.0%]), or multiple group same quadrant (nine of 36 [25.0%]) distribution were significantly higher than malignancy rate in a solitary group of amorphous calcifications (25 of 356 [7.0%]) (P = .004, P = .003, and P = .002, respectively). Of 356 grouped amorphous calcifications, 102 (28.7%) yielded atypical results prompting excision, with three of 102 (2.9%) upgraded to ductal carcinoma in situ at excision. In women younger than 50 years without a personal history of cancer, grouped amorphous calcifications showed four of 127 (3.1%) (95% CI: 0.9, 7.9) were malignant and 39 of 127 (30.7%) were atypical at final histopathology. Conclusion Biopsy of amorphous calcifications remains necessary, with an overall malignancy rate of 10.5%; only 17 of 497 (3.4%) biopsies showed invasive cancer, and all of these were estrogen and progesterone receptor positive. Grouped amorphous calcifications in women younger than 50 years without history of breast or ovarian cancer showed a low malignancy rate of 3.1% (four of 127).
目的 利用当前的影像学、临床和组织病理学标准，确定不同分布的不定形钙化立体定向活检的恶性肿瘤发生率。
材料与方法 本回顾性研究于 2009 年 1 月至 2013 年 9 月期间，对大量的立体定向活检进行了回顾，以确定不定形钙化及其临床、影像学和组织病理学特征。在调整了已知的危险因素后，使用逻辑回归对钙化分布与恶性肿瘤发生率进行相关性分析。
结果 在 1903 例连续活检中，546 例（28.7%）为不定形钙化。排除未切除的非典型病变和同一年内接受多次活检的患者后，497 例病变（494 例女性）仍符合研究要求（中位年龄 52 岁，年龄范围 30-81 岁）。52 例（10.5%；95%置信区间：7.9%，13.5%）证实为恶性病变，其中 17 例（42.7%）为浸润性癌（中位直径 0.3cm，范围 0.1-1.3cm），均为雌激素和孕激素受体阳性且无淋巴结转移。在分段（21 例中的 6 例[28.6%]）、线性（32 例中的 8 例[25.0%]）或多个同一象限组（36 例中的 9 例[25.0%]）分布的钙化恶性肿瘤发生率明显高于不定形钙化的单发组（356 例中的 25 例[7.0%]）（P=.004，P=.003，P=.002）。在 356 例分组不定形钙化中，102 例（28.7%）出现非典型结果，提示需行切除，其中 3 例（2.9%）在切除后升级为导管原位癌。在年龄小于 50 岁且无乳腺癌或卵巢癌个人史的女性中，127 例中的 4 例（3.1%；95%置信区间：0.9%，7.9%）为恶性，39 例（30.7%）为最终组织病理学的非典型。
结论 对不定形钙化的活检仍有必要，总体恶性肿瘤发生率为 10.5%；497 例活检中仅有 17 例（3.4%）为浸润性癌，且均为雌激素和孕激素受体阳性。在年龄小于 50 岁且无乳腺癌或卵巢癌个人史的女性中，不定形钙化的分组恶性肿瘤发生率较低，为 3.1%（127 例中的 4 例）。
