Background: Specimen radiography is important for the biopsy of breast microcalcifications, and MRI is limited in the detection of microcalcifications. It is unknown whether or not the presence of microcalcifications on MRI-guided biopsies is significant. Purpose: To determine whether specimen radiography of MRI-guided biopsy samples provides any added benefits in tissue assessment. Materials and Methods: This is an IRB-approved, HIPPA-compliant retrospective review of MRI-guided biopsy reports whose tissue underwent specimen radiography from 2010 to 2017. Pathology reports were queried to compare samples with and without calcium and reviewed to determine if calcifications correlated with the lesion of interest. If there was a correlation, the original MRI was reviewed. Final pathology reports were also reviewed if excision was performed. Results: A total of 889 patients ages 22 - 85 were included with 140 (15.7%, 140/889) containing calcifications. Of 140 specimens, 119 (85.0%, 119/140) cases separated the calcifications. A total of 41 (34.5%, 41/119) were malignant or high-risk lesions/atypia of which 15 (36.6%, 15/41) showed a higher-grade lesion in the specimen containing calcium. Out of these 15, 4 (26.7%, 4/15) were pathologically associated with calcium; however, pathologic diagnosis was not dependent on the presence of calcifications. All 4 were high-risk lesions and none were malignancies. MRI in these cases showed three enhancing masses and one non-mass enhancement. None were upgraded at excision. Conclusion: The presence of microcalcifications on MRI-guided biopsies does not aid in tissue assessment and does not impact pathologic diagnosis. Specimen radiography provides no added benefits in the setting of MRI-guided biopsies.
References
[1]
Gallager, H.S. (1975) Breast Specimen Radiography. Obligatory, Adjuvant and Investigative. American Journal of Clinical Pathology, 64, 749-755.
https://doi.org/10.1093/ajcp/64.6.749
[2]
Margolin, F.R., Kaufman, L., Jacobs, R.P., Denny, S.R. and Schrumpf, J.D. (2004) Stereotactic Core Breast Biopsy of Malignant Calcifications: Diagnostic Yield of Cores with and Cores without Calcifications on Specimen Radiographs. Radiology, 233, 251-254. https://doi.org/10.1148/radiol.2331031680
[3]
Gümüş, H. et al. (2013) Breast Microcalcification: Diagnostic Value of Calcified and Non-Calcified Cores on Specimen Radiographs. The Breast Journal, 19, 156-161.
https://doi.org/10.1111/tbj.12069
[4]
Yang, W.T. and Tse, G.M. (2004) Sonographic, Mammographic, and Histopathologic Correlation of Symptomatic Ductal Carcinoma in Situ. American Journal of Roentgenology, 182, 101-110. https://doi.org/10.2214/ajr.182.1.1820101
[5]
Stomper, P.C., Geradts, J., Edge, S.B. and Levine, E.G. (2003) Mammographic Predictors of the Presence and Size of Invasive Carcinomas Associated with Malignant Microcalcification Lesions without a Mass. American Journal of Roentgenology, 181, 1679-1684. https://doi.org/10.2214/ajr.181.6.1811679
[6]
Tse, G.M., Tan, P.-H., Pang, A.L.M., Tang, A.P.Y. and Cheung, H.S. (2008) Calcification in Breast Lesions: Pathologists’ Perspective. Journal of Clinical Pathology, 61, 145-151. https://doi.org/10.1136/jcp.2006.046201
[7]
Soo, M.S., Baker, J.A. and Rosen, E.L. (2003) Sonographic Detection and Sonographically Guided Biopsy of Breast Microcalcifications. American Journal of Roentgenology, 180, 941-948. https://doi.org/10.2214/ajr.180.4.1800941
[8]
Mann, R.M., Cho, N. and Moy, L. (2019) Breast MRI: State of the Art. Radiology, 292, 520-536. https://doi.org/10.1148/radiol.2019182947
[9]
van der Velden, A.P.S., Boetes, C., Bult, P. and Wobbes, T. (2009) Magnetic Resonance Imaging in Size Assessment of Invasive Breast Carcinoma with an Extensive Intraductal Component. BMC Medical Imaging, 9, Article No. 5.
https://doi.org/10.1186/1471-2342-9-5
[10]
Kuhl, C.K., et al. (2017) Impact of Preoperative Breast MR Imaging and MR-Guided Surgery on Diagnosis and Surgical Outcome of Women with Invasive Breast Cancer with and without DCIS Component. Radiology, 284, 645-655.
https://doi.org/10.1148/radiol.2017161449
[11]
D’Orsi, C.J., Sickles, E.A., Mendelson, E.B., Morris, E.A., et al. (2013) ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. American College of Radiology, Reston.
