Mammographic casting-type calcification associated with small screen-detected invasive breast cancers: is this a reliable prognostic indicator?

AIM The aim of the present study was to establish whether mammographic casting-type calcification associated with small screen-detected invasive breast cancers is a reliable prognostic indicator. METHODS AND MATERIALS We retrospectively identified 50 consecutive women diagnosed with an invasive cancer less than 15 mm who showed associated casting calcification on their screening mammograms. Controls were identified that showed no microcalcification and were matched for tumour size, histological type and lymph node status. A minimum of 5 years follow-up was obtained, noting recurrence and outcome. Conditional and unconditional logistic regression, depending on the outcome variable, were used to analyse the data, taking the matched design into account in both cases. Where small numbers prohibited the use of logistic regression, Fisher's exact test was used. RESULTS Five deaths from breast cancer occurred out of the 50 cases, of which three were lymph node positive, two were lymph node negative and none were grade 3. None of the 78 control cases died from breast cancer. The difference in breast cancer death rates was significant by Fisher's exact test (p=0.02). Risk of recurrence was also significantly increased in the casting cases (OR=3.55, 95% CI 1.02-12.33, p=0.046). CONCLUSION Although the overall outcome for small screen-detected breast cancers is good, our study suggests that casting calcification is a poorer prognostic factor. The advantage of a mammographic feature as an independent prognostic indicator lies in early identification of high-risk patients, allowing optimization of management.

[1]  J. Hendriks,et al.  Extent, distribution, and mammographic/ histological correlations of breast ductal carcinoma in situ , 1990, The Lancet.

[2]  J. Connolly,et al.  Ductal carcinoma in situ of the breast: correlation between mammographic calcification and tumor subtype. , 1992, AJR. American journal of roentgenology.

[3]  I. Ellis,et al.  The detection of ductal carcinoma in situ at mammographic screening enables the diagnosis of small, grade 3 invasive tumours. , 1997, British Journal of Cancer.

[4]  M. Silverstein,et al.  Use of predictors of recurrence to plan therapy for DCIS of the breast. , 1997, Oncology.

[5]  G Hermann,et al.  Mammographic pattern of microcalcifications in the preoperative diagnosis of comedo ductal carcinoma in situ: histopathologic correlation. , 1999, Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes.

[6]  S. Schnitt,et al.  Identification of patients at high risk for local recurrence after conservative surgery and radiation therapy for stage I or II breast cancer. , 1987, Archives of surgery.

[7]  I. Ellis,et al.  Is the presence of mammographic comedo calcification really a prognostic factor for small screen-detected invasive breast cancers? , 2003, Clinical radiology.

[8]  Philip Smith,et al.  Evaluation of infiltrating ductal carcinomas with a DCIS component: correlation of the histologic type of the in situ component with grade of the infiltrating component. , 1994, Seminars in diagnostic pathology.

[9]  D N Poller,et al.  Correlations between the mammographic features of ductal carcinoma in situ (DCIS) and C-erbB-2 oncogene expression. Nottingham Breast Team. , 1993, Clinical radiology.

[10]  I. Ellis,et al.  Predicting invasion in mammographically detected microcalcification. , 2001, Clinical radiology.

[11]  J. Peterse,et al.  The impact of tumor size and histology on local control after breast-conserving therapy. , 1988, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[12]  G. McKee,et al.  Cytologic diagnosis and grading of ductal carcinoma in situ , 1999, Cancer.

[13]  M. Lagios,et al.  Mammographically detected duct carcinoma in situ. Frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence , 1989, Cancer.

[14]  E. Thurfjell,et al.  Mammographic finding as predictor of survival in 1–9mm invasive breast cancers. Worse prognosis for cases presenting as calcifications alone , 2001, Breast Cancer Research and Treatment.

[15]  I. Ellis,et al.  Screen detected ductal carcinoma in situ (DCIS): overdiagnosis or an obligate precursor of invasive disease? , 2001, Journal of medical screening.

[16]  M. J. Silverstein,et al.  Prognostic classification of breast ductal carcinoma-in-situ , 1995, The Lancet.

[17]  Eusebi,et al.  Long-term follow-up of in situ carcinoma of the breast. , 1994, Seminars in diagnostic pathology.

[18]  E. Kim,et al.  Correlation between mammographic manifestations and averaged histopathologic nuclear grade using prognosis-predict scoring system for the prognosis of ductal carcinoma in situ. , 1999, Clinical imaging.

[19]  C. Elston,et al.  Extent of ductal carcinoma in situ within and surrounding invasive primary breast carcinoma , 2001, The British journal of surgery.

[20]  H. Dinkel,et al.  Is the appearance of microcalcifications on mammography useful in predicting histological grade of malignancy in ductal cancer in situ? , 2000, The British journal of radiology.

[21]  Stephen W Duffy,et al.  A novel method for prediction of long-term outcome of women with T1a, T1b, and 10–14 mm invasive breast cancers: a prospective study , 2000, The Lancet.

[22]  I. O. Ellis,et al.  Confirmation of a prognostic index in primary breast cancer. , 1987, British Journal of Cancer.