Factores predictivos de malignidad en microcalcificaciones de mama sin lesiones asociadas / Predictive factors for malignancy in breast microcalcifications without associated lesions

Introducción. El cribado mamográfico de cáncer de mama permite la detección y el tratamiento temprano de los carcinomas no palpables. Las microcalcificaciones son un hallazgo mamográfico muy importante para la detección de muchos de estos procesos, pero también están presentes en enfermedad benigna de la mama. En este estudio se analizan los factores clínicos y radiológicos que tienen valor predictivo de malignidad. Material y métodos. Se han recogido retrospectivamente 133 casos de biopsias abiertas realizadas a pacientes con hallazgo mamográfico de microcalcificaciones sin lesión asociada. Las características clínicas y radiológicas se correlacionaron con los hallazgos histológicos. Resultados. El 28,6% de las lesiones analizadas fueron malignas, y entre ellas el 65,8% fueron carcinomas ductales in situ. Un 23,1% de los carcinomas infiltrantes presentaron adenopatías positivas. Ningún factor clínico tuvo valor predictivo de malignidad. En el estudio univariante, los factores radiológicos que presentaron significación estadística fueron: el tipo morfológico, según la clasificación de Le Gal, la irregularidad en el tamaño, la irregularidad en la densidad, el número de microcalcificaciones por grupo, el diámetro de la lesión y la presencia de más de un foco de microcalcificaciones. En el estudio multivariante, los factores con valor predictivo independiente fueron: la irregularidad en la densidad, la concentración ≥ 10 microcalcificaciones por grupo, la presencia de más de un foco de microcalcificaciones y el diámetro de la lesión ≥ 10mm. Conclusiones. Aunque ningún factor clínico fue relevante en la predicción de malignidad, las características radiológicas de las microcalcificaciones fueron determinantes en la indicación de una biopsia (AU)

Introduction. Screening mammography allows the early detection and treatment of nonpalpable carcinomas. Microcalcifications are highly important for the detection of many of these malignancies but are also present in benign breast disease. In the present study we analyzed the radiologic and clinical factors associated with malignancy. Material and methods. We retrospectively reviewed 133 patients who underwent open biopsy after a mammographic finding of microcalcifications without an associated lesion. Clinical and radiologic characteristics were correlated with histologic findings. Results. A total of 28.6% of the lesions analyzed were malignant. Of these, 65.8% were ductal carcinoma in situ. Among invasive carcinomas, 23.1% presented lymph node metastasis. No clinical criterion was significant for malignancy. On univariate analysis six radiologic criteria were significant: morphologic type (Le Gal's classification), irregularity of size, irregularity of density, number of microcalcifications per cluster, diameter of the lesion, and the presence of more than one cluster. On multivariate analysis the factors with independent predictive value were: irregularity of density, ≥ 10 microcalcifications per cluster, the presence of more than one cluster, and diameter of the cluster ≥ 10 mm. Conclusions: Although none of the clinical factors analyzed was predictive for malignancy, the radiological characteristics of microcalcifications were determining factors in the indication for biopsy (AU)

[Predictive factors for malignancy in breast microcalcifications without associated lesions]. / Factores predictivos de malignidad en microcalcificaciones de mama sin lesiones asociadas.

INTRODUCTION: Screening mammography allows the early detection and treatment of nonpalpable carcinomas. Microcalcifications are highly important for the detection of many of these malignancies but are also present in benign breast disease. In the present study we analyzed the radiologic and clinical factors associated with malignancy. MATERIAL AND METHODS: We retrospectively reviewed 133 patients who underwent open biopsy after a mammographic finding of microcalcifications without an associated lesion. Clinical and radiologic characteristics were correlated with histologic findings. RESULTS: A total of 28.6% of the lesions analyzed were malignant. Of these, 65.8% were ductal carcinoma in situ. Among invasive carcinomas, 23.1% presented lymph node metastasis. No clinical criterion was significant for malignancy. On univariate analysis six radiologic criteria were significant: morphologic type (Le Gal's classification), irregularity of size, irregularity of density, number of microcalcifications per cluster, diameter of the lesion, and the presence of more than one cluster. On multivariate analysis the factors with independent predictive value were: irregularity of density, > or = 10 microcalcifications per cluster, the presence of more than one cluster, and diameter of the cluster > or = 10 mm. CONCLUSIONS: Although none of the clinical factors analyzed was predictive for malignancy, the radiological characteristics of microcalcifications were determining factors in the indication for biopsy.