Diagnosis and Management of Microcalcification Associated with Ductal Carcinoma in Situ of the Breast

Twenty-two cases of microcalcification (MC) associated with ductal carcinoma in situ (DCIS) between 1988 and 1995 were reviewed and analyzed. The ratio of MC among all DCIS was 32.9%. The most frequent patient group was 4150 years of age and most of the lesions were situated in the upper lateral region. On mammography (MMG), malignancy was easily diagnosed because of its characteristic findings of MC, but it was difficult to differentiate between invasive carcinoma and DCIS. Four types of MC associated with DCIS were proposed as follows : 1) solitary cluster type ; 2) multiple solitary cluster type ; 3) numerous scattered type ; 4) diffuse type. Additionally, the findings of ultrasonography (US) were helpful for diagnosis of DCIS when there were no discrete mass shadows but many echogenic patterns thought to be MC. However, US was not effective for detection of abnormal lesions among the solitary cluster and multiple solitary cluster types. Histopathologically, many cases of the solitary cluster type did not have ductal spread (57%), and some were the non-comedo type (29%). Also, no axillary metastasis was recognized in DCIS with MC. We recommend core needle biopsy or open biopsy for suspected MC associated with DCIS on MMG and/or US, and propose that solitary cluster type is a better candidate for breast-conserving surgery without axillary dissection. For the other three types total mastectomy is mandatory, but no axillary dissection is recommended.