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Abstract

Objective: Microcalcifications are the primary mammographic abnormalities in 40% of nonpalpable breast cancers. The aim of this retrospective study is to compare the diagnostic value of conventional and digital mammography (CMG and DMG) by reviewing the histopathological results of microcalcifications evaluated with stereotactic biopsy together with these two methods. Material and method: The mammography and stereotactic biopsy images and medical records of 464 females who had undergone wire localization for microcalcifications with CMG and DMG between May 2003 and May 2011 were retrospectively evaluated. The histopathology results were compared according to the positive and negative predictive values (PPV and NPV) and the BI-RADS classification. Results: The histopathology was malignant in 57% (120/207) of the microcalcifications detected with CMG and 22.5% (58/257) of those detected with DMG. The malignant pathologies detected on CMG were infiltrative in 55% and in situ in 45%. The malignant pathologies detected on DMG were infiltrative in 43% and in situ in 56.9%. The microcalcifications detected on CMG were distributed as 30 BI-RADS 3 (PPV: 93.3%); 135 BI-RADS 4 (PPV:39%), and 42 BI-RADS 5 (PPV:100%) lesions and the total PPV was 66%. The microcalcifications detected on DMG were distributed as 1 BI-RADS 3 (PPD: 100%), 249 BI-RADS 4 (PPD: 20%), and 7 BI-RADS 5 (PPD:100%) cases and the total PPV was 22%. Conclusion: Detecting microcalcifications, which are not visible on CMG, increases the 'false positivity' rate but the increase in the detection rate of in situ cancers with DMG can be accepted as an advantage of this method

Keywords

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Comparing Conventional and Digital Mammography in Patients With Microcalcifications

Öz

Abstract

Objective: Microcalcifications are the primary mammographic abnormalities in 40% of nonpalpable breast cancers. The aim of this retrospective study is to compare the diagnostic value of conventional and digital mammography (CMG and DMG) by reviewing the histopathological results of microcalcifications evaluated with stereotactic biopsy together with these two methods.

Material and method: The mammography and stereotactic biopsy images and medical records of 464 females who had undergone wire localization for microcalcifications with CMG and DMG between May 2003 and May 2011 were retrospectively evaluated. The histopathology results were compared according to the positive and negative predictive values (PPV and NPV) and the BI-RADS classification.

Results: The histopathology was malignant in 57% (120/207) of the microcalcifications detected with CMG and 22.5% (58/257) of those detected with DMG. The malignant pathologies detected on CMG were infiltrative in 55% and in situ in 45%. The malignant pathologies detected on DMG were infiltrative in 43% and in situ in 56.9%. The microcalcifications detected on CMG were distributed as 30 BI-RADS 3 (PPV: 93.3%); 135 BI-RADS 4 (PPV:39%), and 42 BI-RADS 5 (PPV:100%) lesions and the total PPV was 66%. The microcalcifications detected on DMG were distributed as 1 BI-RADS 3 (PPD: 100%), 249 BI-RADS 4 (PPD: 20%), and 7 BI-RADS 5 (PPD:100%) cases and the total PPV was 22%.

Conclusion: Detecting microcalcifications, which are not visible on CMG, increases the 'false positivity' rate but the increase in the detection rate of in situ cancers with DMG can be accepted as an advantage of this method.

Key Words: Mammography; Digital, Conventional; Microcalcification.

 

Mikrokalsifikasyonlu Hastalarda Konvansiyonel ve Digital Mammografilerin Karşılaştırılması

 

Özet:

Amaç: Nonpalpabl meme kanserlerinin yaklaşık %40‘ında mikrokalsifikasyonlar primer mammografik anormalliklerdir. Bu geriye dönük çalışmada, konvansiyonel ve digital mamografi (KMG ve DMG) eşliğinde stereotaktik biyopsi yapılan mikrokalsifikasyonların histopatolojik sonuçlarıyla beraber değerlendirilerek her iki yöntemin tanısal değerinin karşılaştırılması amaçlanmıştır.

Gereç ve Yöntem: Mayıs 2003-Mayıs 2011 yılları arasındaki DMG ve konvansiyonel KMG eşliğinde mikrokalsifikasyonlara yönelik tel lokalizasyonu yapılan 464 kadın olgunun mamografi ve sterotaktik biyopsi görüntüleri, radyoloji raporları, hastane iletişim sistemindeki patoloji raporları ve epikrizleri geriye dönük olarak incelenmiştir. Histopatoloji sonuçları, pozitif prediktif değer (PPD) ve negatif prediktif değerleri (NPD), BI-RADS klasifikasyonuna göre karşılaştırılmıştır.

Bulgular: KMG’de saptanan mikrokalsifikasyonların %57’si (120/207), DMG’de saptanan mikrokalsifikasyonların %22.5’i (58/257) malign histopatolojiye sahipti. KMG’de saptanan malign patolojilerin %55’ini infiltratif, %45’ini insitu kanserler oluşturmaktaydı. DMG’de saptanan malign patolojilerin %43’ünü infiltratif, %56.9’unu insitu kanserler oluşturmaktaydı. KMG’de saptanan mikrokalsifikasyonların 30’u BI-RADS 3 (PPD: %93.3); 135’i BI-RADS 4 (PPD: %39), 42’si BI-RADS 5 (PPD: %100) olarak bulundu. Total PPD %66’idi. DMG’ de saptanan mikrokalsifikasyonların 1’i BI-RADS 3 (PPD:%100), 249’u BI-RADS 4 (PPD: %20), 7’si BI-RADS 5 (PPD: %100) idi. Total PPD %22 olarak bulundu.

Sonuç: KMG’de göremediğimiz mikrokalsifikasyonların DMG ile saptanabilir olmaları, ‘yalancı pozitif’ olgu sayısını arttırmaktadır ancak DMG ‘nin insitu kanserleri daha fazla sayıda saptayabilmesi yöntemin avantajlarından biri olarak kabul edilebilir.

Anahtar Kelimeler: Mamografi; Dijital, Konvansiyonel; Mikrokalsifikasyon.

Anahtar Kelimeler

• Mamografi; Dijital, Konvansiyonel; Mikrokalsifikasyon

Kaynakça

1. Haydaroğlu A, Dubova S, Özsaran Z. Ege Üniversitesinde meme kanserleri: 3897 olgunun değerlendirilmesi. Meme Sağlığı Dergisi 2005;1:10-2.
2. Dayanır LÖ, Özdemir A. Meme değerlendirmelerinde fizik muayene, ultrasonografi ve mamografi bulgularının karşılaştırılması. ADÜ Tıp Fak Dergisi 2000;1:9-12.
3. Furnival CM. Breast cancer: Current issues in diagnosis and treatment. Aust N Z J. Surg 1997;67:47-58.
4. Humphrey LL, Helfand M, Chan BK, Woolf SH. Breast cancer screening: a summary of the evidence for the U.S. Preventive Service Task Force. Annals of Internal Medicine. 2002;137:347-60.
5. Fletcher SW, Elmore JG. Mammograhic screening for breast cancer. N Engl J Med 2003;348:1672-80.
6. Bent CK, Bassett LW, D'Orsi CJ, Sayre JW. The positive predictive value of BI-RADS microcalcification descriptors and final assessment categories. Am J Roentgenol. 2010;194:1378-83.
7. Bilgen IG, Memiş A, Üstün EE. İşaretleme biyopsisi ile değerlendirilen 550 nonpalpable meme lezyonunun retrospektif incelenmesi. Tanısal ve Girişimsel Radyoloji 2002;8:487-95.
8. Altomare V, Guerrico G, Giacomeli L, Batista C, Carino R, Montesano M, et al. Management of nonpalpable breast lesions in a modern function at breast unit. Breast Cancer Res Treat 2005;93:85-9.

9. Lewin JM, D’Orsi CJ, Hendrick RE, Moss LJ, Isaacs PK, Karellas A, et al. Clinical comparison of fullfield digital mammography and screenfilm mammography for detection of breast cancer. Am J Roentgenol 2002;179:671-7.
10. Skaane P, Young K, Skjennald A. Population-based mammography screening: comparison of screen-film and full-field digital mammography with soft-copy reading –the Oslo I study. Radiology 2003;229:877-84.
11. Skaane P, Skjennald A. Screen-film mammography versus full-field digital mammography with soft-copy reading: randomized trial in a population-based screening program--the Oslo II Study. Radiology. 2004;232:197-204.
12. Pisano ED, Gatsonis C, Hendrick E, Yaffe M, Baum JK, Acharyya S, et al. Diagnostic Performance of Digital versus Film Mammography for Breast-Cancer Screening for the Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group N Engl J Med 2005;353:1773-83.
13. Hasselgren PO, Hummel RP, Fieler MA. Breast biopsy with needle localization: influence of age and mammographic feature on the rate of malignancy in 350 nonpalpable breast lesions. Surgery 1991;110:623-8.
14. Hall FM, Storella JM, Silverstone DZ, Wyshak G. Nonpalpable breast lesions: recommendations for biopsy based on suspicion for carcinoma on mammography. Radiology 1988;167:353-8.
15. Verschuur-Maes AH, van Gils CH, van den Bosch MA, De Bruin PC, van Diest PJ. Digital mammography: more microcalcifications, more columnar cell lesions without atypia. Modern Pathology 2011;24:1191-7.
16. Berg WA, Campassi C, Langenberg P, Sexton MJ. Breast imaging reporting and data system: inter- and intraobserver variability in feature analysis and final assessment. Am J Roentgenol 2000;174:1769-77.
17. Baker JA, Kornguth PJ, Floyd CE. Breast Imaging Reporting and Data System standardized mammography lexicon: observer variability in lesion description. Am J Roentgenol 1996;166:773-8.
18. Orel SG, Kay N, Reynolds C, Sullivan DC. BI-RADS categorization as a predictor of malignancy. Radiology 1999;211:845-50.
19. Karssemeijer N, Bluekens AM, Beijerinck D, Deurenberg JJ, Beekman M, Visser R, et al. Breast Cancer Screening Results 5 Years after Introduction of Digital Mammography in a Populationbased Screening Program. Radiology 2009;253:353-8.