Synchronous benign-appearing calcifications in patients with ductal carcinoma in situ may not be benign

Background: The management of multiple synchronous groups of benign-appearing calcifications in patients with a diagnosis of breast cancer or a high-risk lesion requiring excision is unclear. The purpose of this study was to examine the results of biopsies of synchronous benign-appearing microcalcifications, in patients with a concurrent abnormal pathology result requiring surgery. Methods: A review was performed of all breast stereotactic-guided vacuum biopsies done at Elmhurst Hospital Center (Elmhurst, NY, USA) between January 2006 and February 2009. Patients with an abnormal pathology result that had further biopsies of synchronous benign or probably benign microcalcifications were included. Results: Two hundred and fifty-two patients had abnormal biopsy results. Twenty-eight patients with additional clusters of microcalcifications reported as benign or probably benign underwent 34 additional biopsies. Abnormal pathology results were found in half of these biopsies, changing the surgical plan in 14 patients. In patients with ductal carcinoma in situ (DCIS) this rate was 71%. Four patients had their diagnosis upgraded. Conclusions: In patients with abnormal findings on stereotactic biopsy of microcalcifications, synchronous benign-appearing microcalcifications are associated with a high rate of abnormal pathology. A 'second look' at the mammogram and further biopsy of other clusters of benign-appearing microcalcifications should be considered in patients with DCIS who are planning to undergo breast-conserving treatment.