title: Mammographic extent of microcalcifications and oestrogen receptor expression affect preoperative breast carcinoma in situ size estimation.
abstract: BACKGROUND
  The aim of our study was to establish which clinical, radiologic and pathologic factors could predict the risk of under- and overestimation of the breast ductal carcinoma in situ (DCIS) size when preoperatively measuring the maximum mammographic extent of microcalcifications (MEM).
  
  
  METHODS
  We made a retrospective review of patients with a DCIS treated in our Breast Unit between May 2005 and May 2012. Clinical, pathologic and radiologic data were evaluated as possible predictive factors for over- or underestimation of DCIS size when measuring MEM.
  
  
  RESULTS
  We obtained precise measurements of MEM in 82 patients (84 DCIS lesions). Maximum MEM measurement correctly estimated maximum pathology size in 57 lesions (68.7 %). Patients with a correctly estimated DCIS, with an underestimated DCIS and with an overestimated DCIS significantly differed in DCIS ER expression (p = 0.022) and in maximum MEM measurement (p = 0.000). Constructing two ROC curves, we found that a maximum MEM measurement ≥25 mm and ER expression ≥90 % were both discrimination points for overestimation and ER ≤ 45 % was a discrimination point for underestimation. Using these cutoff points, we defined four groups of patients with different risks of over- and underestimation.
  
  
  CONCLUSIONS
  Risk of over- or underestimation of DCIS size through MEM measurement depends on DCIS ER expression and MEM itself. Identifying which patients are at a significant risk of over- or underestimation could help the breast surgeon when discussing the surgical options with the patient.
authors.affiliation: Breast Surgery, Obstetrics and Gynaecology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain. mvernet@hospitaldelmar.cat.
authors.forename: Maria
authors.identifier: http://orcid.org/0000-0002-5575-2475
authors.initials: M
authors.lastname: Vernet-Tomas
authors.affiliation: Consulting Service on Methodology for Biomedical Research, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003, Barcelona, Spain.
authors.forename: Sergi
authors.initials: S
authors.lastname: Mojal
authors.affiliation: Obstetrics and Gynaecology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: Gamero
authors.affiliation: Breast Surgery, Obstetrics and Gynaecology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: Pau
authors.initials: P
authors.lastname: Nicolau
authors.affiliation: Breast Imaging, Radiology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-Arana
authors.affiliation: Breast Imaging, Radiology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Plancarte
authors.affiliation: Pathology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Corominas
authors.affiliation: Pathology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Serrano-Munne
authors.affiliation: Obstetrics and Gynaecology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Carreras
authors.affiliation: Breast Surgery, Obstetrics and Gynaecology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: Dolors
authors.initials: D
authors.lastname: Sabadell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000071960:Breast Carcinoma In Situ / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016014:Linear Models; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D057234:Preoperative Period; D012372:ROC Curve; D011960:Receptors, Estrogen / Q000378:metabolism; D012189:Retrospective Studies
chemical_list: D011960:Receptors, Estrogen
keywords: Ductal carcinoma in situ; Microcalcifications; Oestrogen receptor; Size estimation