Emrah Çağlar, Zehra Çoşar, Fatma Kızıltepe

Comparing Conventional and Digital Mammography in Patients With Microcalcifications

AbstractObjective: Microcalcifications are the primary mammographic abnormalities in 40% of nonpalpable breast cancers. The aim of this retrospective study is to compare the diagnostic value of conventional and digital mammography (CMG and DMG) by reviewing the histopathological results of microcalcifications evaluated with stereotactic biopsy together with these two methods.Material and method: The mammography and stereotactic biopsy images and medical records of 464 females who had undergone wire localization for microcalcifications with CMG and DMG between May 2003 and May 2011 were retrospectively evaluated. The histopathology results were compared according to the positive and negative predictive values (PPV and NPV) and the BI-RADS classification.Results: The histopathology was malignant in 57% (120/207) of the microcalcifications detected with CMG and 22.5% (58/257) of those detected with DMG. The malignant pathologies detected on CMG were infiltrative in 55% and in situ in 45%. The malignant pathologies detected on DMG were infiltrative in 43% and in situ in 56.9%. The microcalcifications detected on CMG were distributed as 30 BI-RADS 3 (PPV: 93.3%); 135 BI-RADS 4 (PPV:39%), and 42 BI-RADS 5 (PPV:100%) lesions and the total PPV was 66%. The microcalcifications detected on DMG were distributed as 1 BI-RADS 3 (PPD: 100%), 249 BI-RADS 4 (PPD: 20%), and 7 BI-RADS 5 (PPD:100%) cases and the total PPV was 22%.Conclusion: Detecting microcalcifications, which are not visible on CMG, increases the 'false positivity' rate but the increase in the detection rate of in situ cancers with DMG can be accepted as an advantage of this method.Key Words: Mammography; Digital, Conventional; Microcalcification. Mikrokalsifikasyonlu Hastalarda Konvansiyonel ve Digital Mammografilerin Karşılaştırılması Özet:Amaç: Nonpalpabl meme kanserlerinin yaklaşık %40‘ında mikrokalsifikasyonlar primer mammografik anormalliklerdir. Bu geriye dönük çalışmada, konvansiyonel ve digital mamografi (KMG ve DMG) eşliğinde stereotaktik biyopsi yapılan mikrokalsifikasyonların histopatolojik sonuçlarıyla beraber değerlendirilerek her iki yöntemin tanısal değerinin karşılaştırılması amaçlanmıştır.Gereç ve Yöntem: Mayıs 2003-Mayıs 2011 yılları arasındaki DMG ve konvansiyonel KMG eşliğinde mikrokalsifikasyonlara yönelik tel lokalizasyonu yapılan 464 kadın olgunun mamografi ve sterotaktik biyopsi görüntüleri, radyoloji raporları, hastane iletişim sistemindeki patoloji raporları ve epikrizleri geriye dönük olarak incelenmiştir. Histopatoloji sonuçları, pozitif prediktif değer (PPD) ve negatif prediktif değerleri (NPD), BI-RADS klasifikasyonuna göre karşılaştırılmıştır.Bulgular: KMG’de saptanan mikrokalsifikasyonların %57’si (120/207), DMG’de saptanan mikrokalsifikasyonların %22.5’i (58/257) malign histopatolojiye sahipti. KMG’de saptanan malign patolojilerin %55’ini infiltratif, %45’ini insitu kanserler oluşturmaktaydı. DMG’de saptanan malign patolojilerin %43’ünü infiltratif, %56.9’unu insitu kanserler oluşturmaktaydı. KMG’de saptanan mikrokalsifikasyonların 30’u BI-RADS 3 (PPD: %93.3); 135’i BI-RADS 4 (PPD: %39), 42’si BI-RADS 5 (PPD: %100) olarak bulundu. Total PPD %66’idi. DMG’ de saptanan mikrokalsifikasyonların 1’i BI-RADS 3 (PPD:%100), 249’u BI-RADS 4 (PPD: %20), 7’si BI-RADS 5 (PPD: %100) idi. Total PPD %22 olarak bulundu.Sonuç: KMG’de göremediğimiz mikrokalsifikasyonların DMG ile saptanabilir olmaları, ‘yalancı pozitif’ olgu sayısını arttırmaktadır ancak DMG ‘nin insitu kanserleri daha fazla sayıda saptayabilmesi yöntemin avantajlarından biri olarak kabul edilebilir.Anahtar Kelimeler: Mamografi; Dijital, Konvansiyonel; Mikrokalsifikasyon.

Anahtar Kelimeler:

Mamografi; Dijital, Konvansiyonel; Mikrokalsifikasyon

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Objective: Microcalcifications are the primary mammographic abnormalities in 40% of nonpalpable breast cancers. The aim of this retrospective study is to compare the diagnostic value of conventional and digital mammography (CMG and DMG) by reviewing the histopathological results of microcalcifications evaluated with stereotactic biopsy together with these two methods. Material and method: The mammography and stereotactic biopsy images and medical records of 464 females who had undergone wire localization for microcalcifications with CMG and DMG between May 2003 and May 2011 were retrospectively evaluated. The histopathology results were compared according to the positive and negative predictive values (PPV and NPV) and the BI-RADS classification. Results: The histopathology was malignant in 57% (120/207) of the microcalcifications detected with CMG and 22.5% (58/257) of those detected with DMG. The malignant pathologies detected on CMG were infiltrative in 55% and in situ in 45%. The malignant pathologies detected on DMG were infiltrative in 43% and in situ in 56.9%. The microcalcifications detected on CMG were distributed as 30 BI-RADS 3 (PPV: 93.3%); 135 BI-RADS 4 (PPV:39%), and 42 BI-RADS 5 (PPV:100%) lesions and the total PPV was 66%. The microcalcifications detected on DMG were distributed as 1 BI-RADS 3 (PPD: 100%), 249 BI-RADS 4 (PPD: 20%), and 7 BI-RADS 5 (PPD:100%) cases and the total PPV was 22%. Conclusion: Detecting microcalcifications, which are not visible on CMG, increases the 'false positivity' rate but the increase in the detection rate of in situ cancers with DMG can be accepted as an advantage of this method

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