ULTRASOUND OF MICROCALCIFICATIONS DETECTED BY MAMMOGRAPHY

Purpose: The aim of this study is to show the benefits and capabilities of high-frequency ultrasound /US/ examination as part of the evaluation of suspicious mammographic microcalcifications /MC/.

Methods and Materials: 17 patients with suspicious breast MC detected by mammography were included in this study. All of them underwent US scaning (7.5–10MHz transducer with water-bag stnad-off), US guided fine needle aspiation and biopsy. In 14/17 cases MC were identified by US and in 3/17 cases US identi-fied architectural distortion. Biopsy in 10/17 cases proceeded after preoperative US guided methilen blue location, in 3/17 after mammographicaly guided hookwire location and in 2/17 without localization.In 2/17 cases mammographicaly sterotaxic biopsy was performed. All US and mammograficaly detected MC were collerated with histological findings.

Results: Of 17 cases in 14 (14/17;82%) mammografically detected MC were US visible. 10 of them (10/14,71%) were histological confirmed as malignant. 5 of this histological malignant lesions (5/10)were cytological malignant too. Preoperative sonographically guided maethilen blue localization was performed in 3 of these 5 cases (3/5) and other 2 underwent mastectomy because of diffuse malignant MC (histological: 4 invasive ductal carcinomas /IDC/ (size 5mm –3cm); 1 ductal carcinoma in situ /DCIS/ (size 5mm)). The other 5 (5/10) histological malignant lesions with US visible MC were cytological benign. 2 of them (2/5), because of a very small group of mammographically very suspicious MC (5mm) and negative cytology (ductal epithelium /DE/), underwent preoperative mammographicaly guided hookwire localization (boath histological: DCIS). Other 3 (3/5),because of very clear US finding, underwent preoperative US guided metilen blue localization (histological: 1 tumor phylodes malignum (non palpable 4cm lesion with numerous of MC)- cytological: atypical proliferation of DE)); 1 IDC -cytological: proliferation of DE (size: 5mm); 1 DCIS -cytological: DE (size 1cm)). In 4 cases (4/14) with US and mammographically visible MC histological and cytological were benign. 3 of them (3/4) with very clear US finding underwent preoperative US guided methilen blue localization (histological: 2 sclerosing adenosis /entity witch sometimes mimics carcinoma/ – cytological: DE; 1 florid hyperplasia cum radial scar and sclerosing adenosis -cytological: atypical proliferation of DE). The last patient (1/4) underwent preoperative mammographically guided hookwire localization (histological: florid hyperplasia with focal atyphia – cytological: DE). 3 patients without MC on US scaning (3/17) had histological and cytological benign finding. 2 of them (2/3) underwent stereotaxic biopsy because of diffuse MC (histological: sclerosing adenosis – cytological: DE), and 1 underwent preoperative US guided methilen blue localization (histological: sclerosing adenosis -cytological: DE).In all histological findings MC were confirmed.

Conclusions: Given a known mammographic location high-frequency US can identify MC in mayor percentage of cases. This MC can be successfully biopsied after preoperative sonographic gui-ded localization. The advantages of sonographical gui-ded procedures over mammographical guided procedures include lack of ionizing radiation, lower cost, sparing time of procedure. It also improves patient comfort and lack of the breast compression.