title: Microcalcifications in 1657 Patients with Pure Ductal Carcinoma in Situ of the Breast: Correlation with Clinical, Histopathologic, Biologic Features, and Local Recurrence.
abstract: OBJECTIVE
  This study was designed to determine the relationship of microcalcification morphology and distribution with clinical, histopathologic, biologic features, and local recurrence (LR) in patients with pure ductal carcinoma in situ (DCIS) of the breast.
  
  
  METHODS
  All patients with pure DCIS who underwent preoperative mammography at our institution from 1996 through 2009 were identified. Mammographic findings were classified according to the ACR BI-RADS lexicon. Associations between mammographic findings and clinical, histopathologic, biologic characteristics, and LR were analyzed. Statistical inference used multiple logistic regression and Cox proportional hazards regression adjusted for age and confounding due to bias from nonrandomized selection of radiation therapy.
  
  
  RESULTS
  We identified 1657 patients with microcalcifications visualized on mammography. The mean age at diagnosis was 55 years (SD, 11). The mean follow-up was 7 years (range 1-16). Ipsilateral LR was 4 % in segmentectomy (987) and 1.5 % in mastectomy (670) patients. Increased LR risk was seen in patients with dense breast tissue (p < 0.05) and larger DCIS size (p < 0.01). Radiation therapy was associated with a 2.8-fold decrease in the LR risk. Fine linear (branching) microcalcifications were associated with 5.2-fold increase in LR. Extremely dense breast tissue was associated with positive/close margins (p = 0.04) and multicentricity (p < 0.01). Younger women were more likely to have extremely dense breast tissue (p < 0.0001), multicentric disease (p < 0.0004), and undergo mastectomy (p < 0.0001).
  
  
  CONCLUSIONS
  Dense breast tissue, large DCIS size, and fine linear (branching) microcalcifications were associated with increased LR, yet overall LR rates remained low. Extremely dense breast tissue was a risk factor for multicentricity and positive margins in DCIS.
authors.affiliation: Department of Diagnostic Radiology, Unit 1473, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. gmrauch@mdanderson.org.
authors.forename: Gaiane M
authors.initials: GM
authors.lastname: Rauch
authors.affiliation: Department of Biostatistics, Unit 1411, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Hobbs
authors.affiliation: Department of Surgical Oncology, Unit 1434, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
authors.affiliation: Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Marion E
authors.initials: ME
authors.lastname: Scoggins
authors.affiliation: Department of Diagnostic Imaging, Unit 1476, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Benveniste
authors.affiliation: Department of Diagnostic Imaging, Unit 1476, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Park
authors.affiliation: Department of Surgical Oncology, Unit 1434, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Abigail S
authors.initials: AS
authors.lastname: Caudle
authors.affiliation: Department of Biostatistics, Unit 1411, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Fox
authors.affiliation: Department of Radiation Oncology, Unit 1202, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
authors.affiliation: Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Beatriz E
authors.initials: BE
authors.lastname: Adrada
authors.affiliation: Department of Pathology Administration, Unit 0053, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Savitri
authors.initials: S
authors.lastname: Krishnamurthy
authors.affiliation: Department of Diagnostic Radiology, Unit 1459, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Wei T
authors.initials: WT
authors.lastname: Yang
mesh_terms: D001943:Breast Neoplasms / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D002114:Calcinosis / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008327:Mammography; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology*; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors