Research Article

Comparison of core needle biopsy and excisional biopsy findings for suspicious calcifications detected on screening mammography and the upgrade rate: A single-center retrospective analysis

Volume: 19 October 22, 2026
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Comparison of core needle biopsy and excisional biopsy findings for suspicious calcifications detected on screening mammography and the upgrade rate: A single-center retrospective analysis

Abstract

Suspicious breast calcifications detected on mammography may represent a wide spectrum of histopathological findings ranging from benign alterations to malignancy. A nonmalignant result on core needle biopsy (CNB) may occasionally underestimate an underlying malignancy. This study aimed to determine the rate of upgrade from a nonmalignant CNB result to malignancy after surgical excision and to evaluate the association of patient age, calcification size, and Breast Imaging Reporting and Data System (BI-RADS) category with upgrade. This retrospective single-center study included 47 patients who underwent CNB for suspicious mammographic calcifications followed by surgical excision between January 2020 and December 2025. CNB findings were classified as malignant or nonmalignant. Upgrade to malignancy was defined as the detection of ductal carcinoma in situ or invasive breast carcinoma in the surgical specimen after a nonmalignant CNB result. Patients with nonmalignant CNB findings were compared according to upgrade status. The associations of age, calcification size, and BI-RADS category with upgrade were evaluated, and receiver operating characteristic analysis was performed to assess the discriminatory ability of calcification size. CNB revealed malignant pathology in 16 (34.0%) and nonmalignant pathology in 31 (66.0%) patients. Among the 31 patients with nonmalignant CNB findings, malignancy was detected after surgical excision in 10, corresponding to an upgrade rate of 32.3% (95% CI: 16.7–51.4). Calcification size was significantly greater in patients with upgrade than in those without upgrade (19.6±14.1 mm vs. 10.6±9.5 mm, respectively; p=0.048), whereas age was not significantly different between the groups (p=0.352). The upgrade rate was higher in the high radiologic suspicion group comprising BI-RADS 4B, 4C, and 5 lesions than in the remaining BI-RADS categories (53.8% vs. 16.7%); however, this difference did not reach statistical significance (p=0.052). The area under the receiver operating characteristic curve for calcification size was 0.724 (95% CI: 0.496–0.951; p=0.054). A cutoff value of ≥14 mm yielded a sensitivity of 70.0% and a specificity of 85.7%. Among patients selected for surgical excision after CNB of suspicious mammographic calcifications, approximately one-third of those with an initially nonmalignant CNB result were upgraded to malignancy. Larger calcification size was associated with upgrade, while higher BI-RADS categories showed a clinically relevant but statistically nonsignificant trend toward increased upgrade. These findings suggest that calcification size, radiologic suspicion, sampling adequacy, and radiologic-pathologic concordance should be considered together when determining the management of suspicious calcifications with nonmalignant CNB findings.

Keywords

References

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Details

Primary Language

English

Subjects

General Surgery

Journal Section

Research Article

Publication Date

October 22, 2026

Submission Date

August 11, 2026

Acceptance Date

October 20, 2026

Published in Issue

Year 2026 Volume: 19

APA
Gökova, M., Şafak, M. M., Ünal, S., Yılmaz Bozok, Y., Bolat Küçükzeybek, B., & Gür, E. Ö. (2026). Comparison of core needle biopsy and excisional biopsy findings for suspicious calcifications detected on screening mammography and the upgrade rate: A single-center retrospective analysis. Journal of Surgical Arts, 19. https://doi.org/10.4717/jsa.2016205
AMA
1.Gökova M, Şafak MM, Ünal S, Yılmaz Bozok Y, Bolat Küçükzeybek B, Gür EÖ. Comparison of core needle biopsy and excisional biopsy findings for suspicious calcifications detected on screening mammography and the upgrade rate: A single-center retrospective analysis. JSurgArts. 2026;19. doi:10.4717/jsa.2016205
Chicago
Gökova, Melek, Muhammet Mustafa Şafak, Sevgi Ünal, Yeliz Yılmaz Bozok, Betül Bolat Küçükzeybek, and Emine Özlem Gür. 2026. “Comparison of Core Needle Biopsy and Excisional Biopsy Findings for Suspicious Calcifications Detected on Screening Mammography and the Upgrade Rate: A Single-Center Retrospective Analysis”. Journal of Surgical Arts 19 (October). https://doi.org/10.4717/jsa.2016205.
EndNote
Gökova M, Şafak MM, Ünal S, Yılmaz Bozok Y, Bolat Küçükzeybek B, Gür EÖ (October 1, 2026) Comparison of core needle biopsy and excisional biopsy findings for suspicious calcifications detected on screening mammography and the upgrade rate: A single-center retrospective analysis. Journal of Surgical Arts 19
IEEE
[1]M. Gökova, M. M. Şafak, S. Ünal, Y. Yılmaz Bozok, B. Bolat Küçükzeybek, and E. Ö. Gür, “Comparison of core needle biopsy and excisional biopsy findings for suspicious calcifications detected on screening mammography and the upgrade rate: A single-center retrospective analysis”, JSurgArts, vol. 19, Oct. 2026, doi: 10.4717/jsa.2016205.
ISNAD
Gökova, Melek - Şafak, Muhammet Mustafa - Ünal, Sevgi - Yılmaz Bozok, Yeliz - Bolat Küçükzeybek, Betül - Gür, Emine Özlem. “Comparison of Core Needle Biopsy and Excisional Biopsy Findings for Suspicious Calcifications Detected on Screening Mammography and the Upgrade Rate: A Single-Center Retrospective Analysis”. Journal of Surgical Arts 19 (October 1, 2026). https://doi.org/10.4717/jsa.2016205.
JAMA
1.Gökova M, Şafak MM, Ünal S, Yılmaz Bozok Y, Bolat Küçükzeybek B, Gür EÖ. Comparison of core needle biopsy and excisional biopsy findings for suspicious calcifications detected on screening mammography and the upgrade rate: A single-center retrospective analysis. JSurgArts. 2026;19. doi:10.4717/jsa.2016205.
MLA
Gökova, Melek, et al. “Comparison of Core Needle Biopsy and Excisional Biopsy Findings for Suspicious Calcifications Detected on Screening Mammography and the Upgrade Rate: A Single-Center Retrospective Analysis”. Journal of Surgical Arts, vol. 19, Oct. 2026, doi:10.4717/jsa.2016205.
Vancouver
1.Melek Gökova, Muhammet Mustafa Şafak, Sevgi Ünal, Yeliz Yılmaz Bozok, Betül Bolat Küçükzeybek, Emine Özlem Gür. Comparison of core needle biopsy and excisional biopsy findings for suspicious calcifications detected on screening mammography and the upgrade rate: A single-center retrospective analysis. JSurgArts. 2026 Oct. 1;19. doi:10.4717/jsa.2016205

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