Radiologically detectable microcalcifications in histopathologically confirmed ductal carcinoma in situ: The impact of cohort composition on reported prevalence.

PURPOSE: This study aimed to determine the prevalence of radiologically detectable microcalcifications in histopathologically confirmed ductal carcinoma in situ (DCIS) using specimen radiography and to evaluate clinicopathologic factors associated with their presence.

METHODS

A total of 1201 consecutive patients who underwent wire-guided localization for non-palpable breast lesions were retrospectively identified. Patients without histopathologically confirmed DCIS, those without specimen radiographs, and those who had received neoadjuvant systemic therapy were excluded. The final cohort included 100 patients with histopathologically confirmed DCIS. Specimen radiographs were retrospectively reviewed for radiologically detectable microcalcifications, and associations with clinicopathologic variables were analyzed using univariate and multivariable analyses.

RESULTS

Radiologically detectable microcalcifications were identified in 48% of DCIS cases. Subgroup analysis demonstrated marked differences according to cohort composition, with microcalcifications present in 95.8% of pure DCIS cases compared with 32.9% of non-pure cases (p < 0.001). In multivariable analysis, cohort composition and high-grade DCIS remained independently associated with radiologically detectable microcalcifications, whereas necrosis, ER status, and PR status were not independently significant after adjustment. Seventy percent of the cohort had coexisting invasive ductal carcinoma.

CONCLUSION

A substantial proportion of histopathologically confirmed DCIS cases may lack radiologically detectable microcalcifications. These findings suggest that reported calcification prevalence in DCIS may be strongly influenced by cohort composition and study design, particularly differences between screening-enriched and surgically treated populations. Accordingly, the absence of calcifications does not exclude DCIS, and DCIS should remain a diagnostic consideration when suspicious imaging findings other than microcalcifications are present. Complementary multimodality imaging may be helpful in selected patients with suspicious non-calcified imaging findings, reflecting the broader imaging spectrum of DCIS. Further prospective multicenter studies are needed to validate these observations.