Mammographic extent of microcalcifications and oestrogen receptor expression affect preoperative breast carcinoma in situ size estimation

Breast Cancer. 2017 May;24(3):466-472. doi: 10.1007/s12282-016-0729-9. Epub 2016 Sep 17.


Background: The aim of our study was to establish which clinical, radiologic and pathologic factors could predict the risk of under- and overestimation of the breast ductal carcinoma in situ (DCIS) size when preoperatively measuring the maximum mammographic extent of microcalcifications (MEM).

Methods: We made a retrospective review of patients with a DCIS treated in our Breast Unit between May 2005 and May 2012. Clinical, pathologic and radiologic data were evaluated as possible predictive factors for over- or underestimation of DCIS size when measuring MEM.

Results: We obtained precise measurements of MEM in 82 patients (84 DCIS lesions). Maximum MEM measurement correctly estimated maximum pathology size in 57 lesions (68.7 %). Patients with a correctly estimated DCIS, with an underestimated DCIS and with an overestimated DCIS significantly differed in DCIS ER expression (p = 0.022) and in maximum MEM measurement (p = 0.000). Constructing two ROC curves, we found that a maximum MEM measurement ≥25 mm and ER expression ≥90 % were both discrimination points for overestimation and ER ≤ 45 % was a discrimination point for underestimation. Using these cutoff points, we defined four groups of patients with different risks of over- and underestimation.

Conclusions: Risk of over- or underestimation of DCIS size through MEM measurement depends on DCIS ER expression and MEM itself. Identifying which patients are at a significant risk of over- or underestimation could help the breast surgeon when discussing the surgical options with the patient.

Keywords: Ductal carcinoma in situ; Microcalcifications; Oestrogen receptor; Size estimation.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Breast Carcinoma In Situ / diagnostic imaging*
  • Breast Carcinoma In Situ / pathology*
  • Breast Carcinoma In Situ / surgery
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / surgery
  • Calcinosis / diagnostic imaging*
  • Calcinosis / pathology
  • Carcinoma, Intraductal, Noninfiltrating / diagnostic imaging
  • Carcinoma, Intraductal, Noninfiltrating / pathology
  • Carcinoma, Intraductal, Noninfiltrating / surgery
  • Cohort Studies
  • Female
  • Humans
  • Linear Models
  • Mammography / methods
  • Middle Aged
  • Preoperative Period
  • ROC Curve
  • Receptors, Estrogen / metabolism
  • Retrospective Studies


  • Receptors, Estrogen