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This article is part of the supplement: British Society of Breast Radiology Annual Scientific Meeting 2012

Poster presentation

Impact of full-field digital mammography on diagnostic work-up and surgical management of mammographic microcalcification

SM Bundred1*, J Zhou1, S Whiteside1, J Morris2 and NJ Bundred2

  • * Corresponding author: SM Bundred

Author Affiliations

1 University Hospital South Manchester, Manchester, UK

2 University of Manchester, UK

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Breast Cancer Research 2012, 14(Suppl 1):P20  doi:10.1186/bcr3275


The electronic version of this article is the complete one and can be found online at: http://breast-cancer-research.com/content/14/S1/P20


Published:9 November 2012

© 2012 Bundred et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

Full-field digital mammography (FFDM) increases detection of benign and malignant calcified breast lesions. Accurate nonoperative diagnosis of malignant impalpable breast lesions minimises numbers of therapeutic surgical procedures. Correct diagnosis of malignant mammographic microcalcification (MM) is important because upgraded lesions require repeat surgical procedures in 57% of cases (NHSBSP Audit 2012).

Methods

Screening and symptomatic women with MM (n = 1,479) were reviewed to determine the impact of FFDM (imaging with FFDM only since April 2010) on the positive predictive value (PPV), diagnostic accuracy and surgical management of MM. Demographic information, preoperative and postoperative diagnosis and number of surgical procedures were recorded for Group 1 (August 2007 to March 2010: n = 711) and Group 2 (April 2010 to May 2011: n = 768).

Results

Reduction in PPV of biopsy for MM was observed (Group 1, 42.6%: Group 2, 32.7%; P < 0.0001). Correct or concordant nonoperative diagnosis increased with FFDM (Group 1, 89% vs. Group 2, 95%; P < 0.0001) and was achieved more often at first attempt (Group 1, 80.6% vs. Group 2, 89.5%; P < 0.0001). More lesions under 5 mm were biopsied using FFDM (Group 1, 15%; Group 2, 20.4%; P = 0.008). Accurate preoperative diagnosis of malignancy permitted single-stage surgery in 77.4% Group 2 versus 67.9% Group 1 (P = 0.017). For DCIS cases, similar first-line mastectomy rates were observed (Group 1, 30.3% vs. Group 2, 33.3%, P = NS). Fewer B3/4 lesions upgraded at surgery (Group 1, 48.7% vs. Group 2, 20%; P = 0.011).

Conclusion

Nonoperative work-up of MM using FFDM reduced second therapeutic procedures for MM, decreased upgrade of B3/4 lesions at diagnostic surgery, but increased benign nonoperative biopsies for MM.