Radiology, Vol 179, 111-114, Copyright © 1991 by Radiological Society of North America
Calcifications in breast biopsy specimens: discrepancies in radiologic- pathologic identification
MA Stein and MS Karlan
Department of Radiology, Beverly Hills Medical Center, Los Angeles, CA 90035.
To analyze the effectiveness and accuracy of the diagnostic process from
screening mammography to final diagnosis at pathologic examination, the
authors conducted a prospective study of 277 consecutive patients who
underwent 291 mammographically directed biopsies of nonpalpable lesions. Of
the 170 lesions that demonstrated findings consistent with calcification on
preoperative mammograms and radiographs of specimens, 12 (7.1%) were not
described by the pathologist as being calcified. These discrepancies were
due to inadequate sampling in three cases (25%), lack of explicit
description by the pathologist in four (33%), presence of oxalate crystals
that required examination with polarizing lenses in two (17%), and
unexplained loss of tissue probably related to processing in three (25%).
Of the 121 lesions that did not demonstrate findings consistent with
calcification at radiography, eight (6.6%) were described as calcified by
the pathologist. The authors recommend a protocol for avoiding these
discrepancies that involves performance of a more comprehensive examination
of histologic sections by the pathologist, including the use of polarizing
lenses, if necessary, and radiographic reexamination of paraffin-embedded
tissue blocks with subsequent step sectioning by the pathologist when
results are positive.
