Jacky Luiten

Recall and outcome of screen‐detected microcalcifications of mammography screening | 81 5 clear to which degree histologic features of DCIS can be estimated by using the patterns of microcalcifications alone. 30 Surgery, including additional radiation therapy in case of breast‐conserving surgery, remains the recommended choice for DCIS treatment. 33 Most women with DCIS in our study were treated with breast‐conserving surgery. In almost 5% of all surgically treated women, no residual DCIS was found in the surgical specimen, suggesting that all DCIS was removed at SCNB as has also been described in a recent study by Dubrovsky et al . 34 in 14% of all surgically treated women. In the study by Dubrovsky et al ., omission of additional radiation therapy did not alter the local recurrence rate. Vacuum‐assisted excision biopsy devices can remove more tissue than SCNB and may be the future therapy for patients with small groups of clustered microcalcification‐associated DCIS. 35,36 A wait‐and see strategy for low grade and intermediate grade DCIS may be favored over surgical intervention if subsequent mammography shows no residual calcifications. Our study has some limitations. Unfortunately, individual data at a woman level could not be retrieved for repeat screening examinations. Therefore, possible within‐subject dependencies of the data in repeat screening examinations could not be modeled and estimated. Given these limitations in the data, we could only analyze all subsequent screening examinations (which may be dependent) as one group. Furthermore, we were not able to reliably retrieve the detailed radiologic features on morphologic characteristics and distribution of microcalcifications because they were not specified in our data. Characterizing radiologic features of suspicious microcalcifications to search for patterns that correlate with more aggressive underlying disease might be a desirable next step toward a more selective use of SCNB in case of screen‐detected microcalcifications. Because it is not yet clear to what extent histologic features of DCIS can be estimated by the patterns of microcalcifications alone, SCNB is still considered mandatory in the work‐up of these lesions to date. In conclusion, the recall rate of suspicious microcalcifications at mammographic screening significantly increased over the past two decades, while the ductal carcinoma in situ detection rate increased less rapidly at the expense of a lower positive predictive value of recall.