Questioning Protocols: The Case Against Routine Post-Lumpectomy Mammography for Patients with Calcifications

Document Type

Conference Proceeding

Publication Date

7-8-2025

Publication Title

Ann Surg Oncol

Keywords

adult, aged, breast cancer, calcification, cancer registry, cohort analysis, conference abstract, diagnosis, drug therapy, ductal breast carcinoma in situ, female, histology, human, lumpectomy, major clinical study, male, mammography, minimal residual disease, needle biopsy, protocol, radiotherapy, retrospective study, special situation for pharmacovigilance, surgery

Abstract

Background/Objective: Post-lumpectomy mammography (PLM) is commonly recommended following lumpectomy for suspicious calcifications prior to initiating adjuvant radiation therapy to ensure all malignancy-associated calcifications have been resected. PLM has been routinely used at our institution for patients who presented with malignant calcifications and were treated with breast conservation therapy (BCT). We evaluated the utility of PLM in detecting residual breast cancer to determine if it is necessary for all patients who had malignant calcifications at the time of diagnosis. Methods: A retrospective analysis was performed by querying the Henry Ford Breast Cancer Registry for all patients with a malignant diagnosis on core biopsy who were managed with BCT across 5 sites within our network in 2021. Results: A total of 456 patients were included in the study. Of these, 156 (34.2%) had calcifications on initial imaging and 124 were recommended for PLM at their initial tumor board presentation. The histology of the initial biopsy in patients with calcifications was predominantly DCIS (64/156, 41.0%) and IDC (53/156, 33.9%). PLM was completed for 128 patients after post-operative tumor board discussion. In this cohort, 24 patients demonstrated calcifications on their PLM (18.8%). After radiology review, 13/24 (54.2%) of these PLM-detected calcifications were read as benign and required no additional workup, while 11/24 (45.8%) demonstrated suspicious calcifications requiring additional histologie confirmation, either with stereotactic core needle biopsy or re-excision. Additional work-up with biopsy or re-excision was completed in all 11 of these patients. In 4 /l 1 patients, residual disease was detected on additional sampling, all of which was determined to be DCIS on pathological diagnosis. The average span of calcifications on pre-operative imaging in these patients with DCIS in residual calcifications following lumpectomy and additional sampling was 66.3 mm. Conclusions: Only 4 of the 128 patients who were recommended for PLM demonstrated residual disease (3.1%), and the mean span of calcifications in these patients was 66.3 mm (Range 55.0-84.0 mm). Due to the extremely low likelihood of detecting residual disease in patients who initially presented with malignant calcifications, it can be concluded that routine use of PLM is not necessary and should be performed only for patients at high-risk of residual disease. Based on the results from our institution, high risk could be defined as having extensive malignant calcifications, greater than 50 mm, on mammogram at the time of diagnosis.

Volume

32

Issue

2

First Page

S529

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