Analysis of stereotactic biopsies performed on suspicious calcifications identified within 24 months after completion of breast conserving surgery and radiation therapy for early breast cancer: Can biopsy be obviated?

Background: To determine the cancer yield of stereotactic biopsy of suspicious calcifications identified within 24 months after breast conservation therapy (BCT). Methods: Retrospective review of stereotactic biopsies performed during 2009–2013 for suspicious calcifications in the ipsilateral breast of patients who completed BCT. Results: 94/2773 (3.4%) had stereotactic biopsies for suspicious calcifications in the ipsilateral breast; 7/94 (7.4%) had DCIS (6) or invasive (1) cancer; 5/7 occurred in the same breast quadrant as the primary. All 7 originally had negative surgical margins (≥2 mm); 6 received whole breast irradiation, and 2 received adjuvant chemotherapy + endocrine therapy. Median time to detection was 11 months (range, 6–20 months). There was a strong association between calcification morphology (particularly pleomorphic) and likelihood of malignancy (p = 0.008). Conclusions: Stereotactic biopsy of calcifications identified within 24 months post-BCT has a 7% cancer yield. Tissue biopsy should be performed rather than imaging followup alone when breast calcifications have suspicious morphology.