Segregation of radiographic calcifications in stereotactic core biopsies of breast: is it necessary?

Stereotactic-needle core biopsy (SNCB) is increasingly being used for the evaluation of mammographic calcifications. Radiography of SNCB specimens is essential to confirm the presence of calcifications within the biopsy material. To aid and direct the pathologist, it has been recommended that SNCBs be separated into those with and without radiographic calcifications and separately embedded. However, the utility of this separation to the pathologist has not been established. We reviewed 80 consecutive 11 gauge vacuum-assisted SNCB procedures performed for mammographic calcifications. The core biopsies were separated by the radiologist into those with and without radiographic calcifications ("calcs" and "no calcs"). Twenty-nine of 80 (36%) of the "calcs" cores were atypical or malignant, while 23 of 80 (29%) of the "no calcs" cores were atypical or malignant (chi(2) = 0.63, p = NS). The same diagnosis was rendered in the "calcs" and "no calcs" specimens in 61/80 cases (76%). Two cases of ductal carcinoma in situ, four cases of atypical ductal hyperplasia and 13 cases of fibroadenoma were diagnosed in the "calcs" cores only. However, in all cases where the pathologic lesion was seen in the "calcs" core only, the pathologic lesion was present on initial H&E levels and would have been diagnosed even in the absence of core segregation. Deeper sections were deemed necessary in seven of the 80 cases. No change in diagnosis was made on the basis of these deeper sections, even in the cases where histologic calcifications appeared on deeper sections. Separate embedding of SNCBs into those with and without radiographic calcifications does not appear to be of great utility to the pathologist. Equal attention should be given to all cores in the setting of SNCBs for mammographic calcifications.