Radiologic-Pathologic CorrelationMicrocalcifications of the breast: a mammographic-histologic correlation study using a newly designed Path/Rad Tissue Tray
Introduction
Over the course of the last 3 decades, the introduction of screening mammography and other imaging modalities has greatly increased awareness and knowledge of early-stage breast cancers. It has been shown that the core needle biopsy (CNB) procedure is considered to be the preferential next step after suspicious radiographic findings on screening mammography [1], [2], [3], [4].
As mammography screening has increased, imaging-histologic discordance has become a significant issue that, in the absence of an adequate multidisciplinary approach, can lead to incorrect or delayed diagnoses as well as unnecessary surgical interventions. Investigators have quickly realized the importance of a multidisciplinary approach with the collaboration of radiologists, pathologists, and surgeons for accurate diagnosis to ensure the success of any CNB program [5]. Hurdles such as workforce, time, and geographic constrains are classic examples for the reasons why interdisciplinary programs were shown to be difficult. However, we at the University of Kansas Medical Center (KUMC) overcame such hurdles through the use of weekly audio-video conferencing, which allowed simultaneous viewing of radiologic and histologic materials by both specialists [6]. In their meetings, the different specialists discuss their findings and resolve any differences between radiology images and pathology findings to create an integrated diagnostic report and treatment recommendation for each patient.
Previous studies have shown that histologic correlation with mammographically detected calcification is somewhere between 90% and 95% of cases, with 5% to 10% of cases being considered to be false negative [2], [7]. Currently, there is no standardized interdisciplinary protocol for evaluating microcalcifications in such samples. This is, in part, due to the lack of a clear understanding of either the radiologic or the histologic description of calcification, leading to interobserver and intraobserver variabilities in reporting such findings. In addition, some pathologists consider the presence of microcalcifications of any size, anywhere in the specimen as sufficient evidence of sampling of targeted lesion by the radiologist. Very few studies have attempted to address the issue of mammographic-histologic correlation of microcalcifications in CNB of the breast [8], [9], [10], [11], [12].
This study was undertaken to standardize the procedure of CNB program in correlating histologic mammographically detectable calcification using specially designed Path/Rad Tissue Trays (patent pending, University of Kansas).
Section snippets
Materials and methods
Four hundred forty CNBs with mammographic evidence of calcification were selected for the study. This retrospective study was approved by the institutional research committee at the University of Kansas Medical Center. The mean age of the patients was 56.4 years (range, 28-83 years). Cases were randomly divided into 2 groups: 369 biopsies obtained from 321 patients without the use of tissue trays and 71 biopsies obtained from 60 patients with the use of tissue trays. All patients underwent
Results
Table 1 shows the histologic description of all cases studied. Four hundred forty specimens were obtained from a total of 381 patients. Most cases were benign, varying from nonproliferative and proliferative fibrocystic changes to papillomas, fibroadenomas, fibrosis, fat necrosis, and cases with no diagnostic abnormalities. Sixty-one randomly selected malignant cases were included in this study, including 49 ductal carcinoma in situ cases, 10 invasive ductal carcinomas, and 2 invasive lobular
Discussion
We illustrate that a standard approach of incorporating a novel device, the Path/Rad Tissue Tray, can significantly increase rates of concordance between histology and radiology findings for CNB specimens. Currently, 36.7 million mammograms [13] result in more than 1 million radiologically guided biopsies for pathologic evaluation annually [14], [15], [16]. Overall rates of radiologic-pathologic discordance of CNB analysis have ranged from 1% to 6% [17]. We have reached across the traditional
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Cited by (12)
Error Reduction and Diagnostic Concordance in Breast Pathology
2022, Surgical Pathology ClinicsCitation Excerpt :If this fails to reveal calcifications, further evaluation through deeper histologic sections (additional levels) can be considered. At least one study has demonstrated that calcifications not identified in the initial levels are often present in deeper sections.54 If additional levels do not reveal calcification the tissue block can be imaged by radiograph; this can be helpful when multiple blocks are present to avoid unnecessary leveling of material unlikely to have calcifications.
Study of Contrast-to-Noise Ratio performance of a Medipix3RX CdTe detector for low dose mammography imaging
2021, Nuclear Instruments and Methods in Physics Research, Section A: Accelerators, Spectrometers, Detectors and Associated EquipmentUnderlining the complexity of the structural and chemical characteristics of ectopic calcifications in breast tissues through FE-SEM and μFTIR spectroscopy
2016, Comptes Rendus ChimieCitation Excerpt :At this point, we may recall that the presence of calcification may induce a significant modification of the cellular metabolism, an inflammation or a modification of the phenotype [6,7]. Breast calcifications defined as calcium deposits within breast tissue have thus been at the core of numerous publications [8–25]. One of the difficulties comes from the fact that breast calcifications can arise from a vast number of aetiologies.
Chemical diversity of calcifications in thyroid and hypothetical link to disease
2016, Comptes Rendus ChimieCitation Excerpt :For organs producing or in contact with biological fluids such as salivary glands, pancreas, and testis, the presence of mineral or organic deposits has been already underlined [50–52]. More precisely, different investigations have pointed out the chemical diversity of such pathological calcifications present in breast [53,54], kidney [55–57], cartilage [58] and prostate [59,60]. Such chemical diversity reflects the fact that these entities are related to very different diseases including genetic disorders, acquired diseases, eating disorders, infection or cancer.
Grating-based darkfield imaging of human breast tissue
2013, Zeitschrift fur Medizinische PhysikCitation Excerpt :Effectively, calcifications are clearly visible from a size exceeding 500 μm. The concordance between radiological findings of microcalcifications and histopathological correlates is quite high with about 90 to 95 % [3]. Some methods have been considered to improve the diagnostic accuracy concerning microcalcifications.