Management of suspicious or indeterminate calcifications and impact on local control

The current study was undertaken to determine the potential advantage associated with complete removal of suspicious or indeterminate calcifications (SIC) before the initiation of irradiation as part of breast conservation therapy (BCT).

Of 2045 patients treated with BCT at Yale University School of Medicine (New Haven, Connecticut) and satellite facilities before 2002, 111 women, included 3 patients with bilateral disease, had a postexcision preirradiation mammogram (PREMAMMO) to evaluate residual SIC. Thus, 114 breasts were at risk for local disease recurrence. Seventy-five breasts at risk had no residual SIC and proceeded to undergo radiotherapy (XRT) without further surgery or mammography. Of the remaining 39 breasts at risk, only 3 underwent a PREMAMMO with documented removal of all calcifications (DRC). Thirty-six breasts at risk proceeded to XRT with either known SIC or with nondocumented removal of calcifications (NDRC) after another excision.

Of the 78 breasts at risk with DRC via PREMAMMO, there were 7 local failures (LF) and 1 distant failure. Of the 36 breasts with NDRC via PREMAMMO, there were 7 LF and 1 regional failure. Of the 34 breasts who underwent reexcision after detection of SIC by PREMAMMO, 20 (59%) were found to have residual disease.

Patients with DRC were found to have better local control than patients with NDRC. In addition, the presence of SIC on a PREMAMMO was associated with a high probability of detecting residual disease.