Ultrasonography mapping combined with mammography before breast-conserving surgery for primary breast cancer with microcalcifications: a novel approach.
BACKGROUND
Evaluation for the spread of breast cancer with microcalcifications is challenging, because the microcalcifications sometimes spread beyond the lesions detectable by ultrasonography (US). An original method for preoperative mapping was performed for such lesions, using US in combination with mammography (MG) (US + MG mapping) before breast-conserving surgery (BCS).


METHODS
A total of 885 consecutive patients underwent BCS for primary breast cancer. Of the 885 patients, 154 (17.4%) with ductal carcinoma in situ or invasive carcinoma having microcalcifications underwent US + MG mapping preoperatively. Five patients who received neoadjuvant chemotherapy and 17 patients who were lost to follow-up were excluded. Accordingly, 133 lesions in 132 patients were retrospectively evaluated. The associations among this method, surgical margin (positive, close, or negative), pathologic characteristics, the area of the lesion within the specimen, and local recurrence rate during 5 years of follow-up were analyzed.


RESULTS
The median age and follow-up duration were 51.3 years (range, 28-80 years) and 71.4 months (range, 60-79 months), respectively. The surgical margin was negative in 96 lesions (72.2%), close in 27 lesions (20.3%), and positive in 10 lesions (7.5%). Local recurrence was noted in 1 patient (0.8%). There was no significant association between surgical margin status and the presence of invasive carcinoma. Larger lesion area was significantly associated with positive or close margin (P = .027).


CONCLUSIONS
US + MG mapping is useful and results in a high complete-resection rate and an extremely low 5-year local recurrence rate.
Department of Radiology, St Luke's International Hospital, Tokyo, Japan. Electronic address: gensuke@gmail.com.
Gensuke
G
Akaike
Department of Radiology, St Luke's International Hospital, Tokyo, Japan.
Hiroko
H
Tsunoda
Department of Breast Surgical Oncology, St Luke's International Hospital, Tokyo, Japan.
Naoki
N
Hayashi
Department of Breast Surgery, Yokohama Asahi Chuo Hospital, Yokohama, Japan.
Toshinao
T
Onoda
Department of Radiology, St Luke's International Hospital, Tokyo, Japan.
Satoshi
S
Honda
Department of Pathology, St Luke's International Hospital, Tokyo, Japan.
Koyu
K
Suzuki
Center for Clinical Epidemiology, St Luke's Life Science Institute, Tokyo, Japan.
Sachiko
S
Ohde
Department of Breast Surgical Oncology, St Luke's International Hospital, Tokyo, Japan.
Hideko
H
Yamauchi
Department of Radiology, St Luke's International Hospital, Tokyo, Japan.
Yukihisa
Y
Saida
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D064847:Multimodal Imaging; D011859:Radiography; D012189:Retrospective Studies; D014463:Ultrasonography
Breast conserving surgery; Mammography; Microcalcifications; Preoperative mapping; Ultrasonography