Abstract P3-01-04: Surgical management of mammographic microcalcification is improved by full field digital mammography (FFDM)

Abstract Background: Preoperative diagnosis of impalpable breast lesions correlates closely with the number of surgical procedures required for treatment. Correct diagnosis of mammographic microcalcification as DCIS or invasive cancer is important because lesions upgraded to malignant diagnosis at surgery require repeat surgical procedures in 44% of cases (BASO Audit 2011). Methods: To determine the impact of FFDM (FFDM only since April 2010) on diagnostic accuracy, positive predictive value (PPV) and surgical management of MM. Screening and symptomatic women with mammographic microcalcification (n = 1125) in one visit were reviewed. Demographic information; pre and post operative diagnosis and number of surgical procedures were recorded for pre FFDM (8/ 2007 to 3/2010: n=710) and post FFDM (4/2010 to 5/2011: n=413). Results: Overall 299 (106 invasive) and 144 (62 invasive) malignant lesions were diagnosed before and after FFDM introduction. Reduction in PPV of biopsy for mammographic microcalcification was observed (SFM PPV 42.6%: FFDM PPV 34.6% (p < 0.01)). Upgrade of B3/4 lesions reduced (SFM 50% (21/42) vs. FFDM 21.7% (5/23): p < 0.05) and pre-operative diagnosis of DCIS improved (88.6% vs. 94%) using digital mammography. Correct histological pre-operative diagnosis permitted a single therapeutic operation for 76.7%, compared to 66% of mammographic microcalcification where pre-operative diagnosis was inaccurate (p < 0.001). Re-excision rates for DCIS lesions >20mm fell from 34.1% (60/176) to 21.1% (19/90) with FFDM (p <0.05). Conclusions: Correct pre-operative diagnosis of mammographic microcalcification using FFDM has reduced second therapeutic procedures for mammographic microcalcification, decreased upgrade of B3/4 lesions at diagnostic surgery, but increased benign non-operative biopsies for mammographic microcalcification. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-01-04.