Microcalcifications associated with ductal carcinoma in situ: mammographic-pathologic correlation

Because of the large scale use of mammography, the incidence of ductal carcinoma in situ (DCIS) has been increased fivefold to sixfold. The majority of these tumors are detected by mammographically significant microcalcifications. Their mammographic and histologic appearance is rather characteristic for the different types of DCIS. Microcalcifications associated with poorly differentiated DCIS appear on the mammogram as either linear, often branching, or as granular microcalcifications which are usually coarse. They correspond to the amorphous type calcifications on histology. Microcalcifications associated with well-differentiated DCIS appear on the mammogram usually as multiple clusters of fine granular microcalcifications, which correspond to the clusters of laminated, crystalline calcifications on histology. The distribution of DCIS is typically unicentric and segmental. In a series of 119 mastectomies, only a single case had a multicentric distribution. Based on the extent of microcalcifications, mammography usually underestimates the size of DCIS; although this discrepancy is less than 2 cm in 80% to 85% of the cases if state-of-the-art mammography, including magnification views, is used. Close co-operation between radiologist, pathologist, and surgeon is essential for the optimum management of patients with DCIS.