Digital mammography: more microcalcifications, more columnar cell lesions without atypia

Area of Science:

• Radiology
• Pathology
• Breast Imaging

Background:

• Columnar cell lesions (CCLs) are characterized by microcalcifications on mammography.
• Full-field digital mammography (FFDM) offers improved detection of microcalcifications compared to screen-filmed mammography (SFM).

Purpose of the Study:

• To analyze the incidence of columnar cell lesions in breast core needle biopsies (CNBs) comparing FFDM and SFM periods.
• To investigate if FFDM's higher sensitivity for microcalcifications leads to increased CCL diagnoses.

Main Methods:

• Retrospective review of 3437 breast CNBs from 55,159 mammographies across three hospitals.
• Comparison of CNB rates, indications (microcalcifications, density), and CCL proportions between SFM and FFDM eras.
• Statistical analysis using chi-squared tests and adjusted prevalence ratios for age and hospital.

Main Results:

• CNB rates per mammogram increased from 5.0% in the SFM era to 7.6% in the FFDM era (P<0.0001).
• Microcalcifications were diagnosed more frequently with FFDM (adjusted prevalence ratio: 1.14).
• Columnar cell lesions were diagnosed more often in the FFDM era (10.8% vs 4.9%, adjusted prevalence ratio: 1.93), primarily due to an increase in CCLs without atypia.

Conclusions:

• Full-field digital mammography implementation is associated with an increased detection of microcalcifications.
• This leads to a higher rate of breast core needle biopsies and a significant increase in the diagnosis of columnar cell lesions, especially those without atypia.