Sonographic evaluation of mammographically detected microcalcifications without a mass prior to stereotactic core needle biopsy.
OBJECTIVE
The purpose of this prospective study was to evaluate the clinical usefulness of sonographically re-evaluating areas of microcalcification found mammographically before undertaking stereotactic core needle biopsy (SCNB).


METHODS
Patients with nonpalpable breast lesions appearing as microcalcifications on mammograms and who had been referred to us for SCNB were re-evaluated sonographically before the procedure. None of the breast lesions had been associated with a density on the mammograms, and the initial sonographic evaluations had been negative. Using the mammograms for correlation, we meticulously re-evaluated the areas of microcalcifications sonographically using a high-frequency linear-array transducer. The sonographic and histopathologic results were then reviewed and correlated. The sonographic findings and visibility of the mammographically detected microcalcifications were analyzed by the 2-tailed Fisher's exact test and the chi-square test.


RESULTS
Sixty-six patients, who had 68 cases of microcalcifications, were enrolled. Thirteen of the 66 patients underwent surgery, and 9 of the 13 were found to have breast carcinoma. In the sonographic re-evaluation before SCNB in these 9 patients, an associated soft tissue mass was demonstrated in 5 patients but not in the other 4. Sonographic re-evaluation also revealed abnormalities in 24 of 68 cases (35.3%), in contrast to the negative findings on the initial sonography. Using the chi-square test to identify a trend, we found that the percentage of cases that were sonographically visible was highest for clustered benign microcalcifications and lowest for segmental benign microcalcifications (p < 0.0001).


CONCLUSIONS
In breast lesions that appear as microcalcifications without an associated mass on mammograms, pre-SCNB sonographic re-evaluation with a high-frequency transducer can depict microcalcifications, particularly the clustered ones, and can detect small associated masses. Although the absence of a sonographically detectable mass in areas of mammographically detected microcalcifications does not guarantee the absence of cancer, the presence of an associated mass on sonography should warrant close follow-up in the case of negative results to avoid a delay in the diagnosis of breast carcinoma.
Department of Diagnostic Radiology, Chang Gung Memorial Hospital, 5 Fu-Hsing Road, Tao Yuan Hsien, Taiwan.
Yun-Chung
YC
Cheung
Yung-Liang
YL
Wan
Shih-Cheh
SC
Chen
Kar-Wai
KW
Lui
Shu-Hang
SH
Ng
Kee-Min
KM
Yeow
Kam-Fai
KF
Lee
Swei
S
Hsueh
D000328:Adult; D001707:Biopsy, Needle / Q000379:methods; D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000000981:diagnostic imaging*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002114:Calcinosis / Q000000981:diagnostic imaging*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D011446:Prospective Studies; D016217:Ultrasonography, Mammary