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  • Open Access

PB.22: Does the Nottingham predictor of bidimensional product of calcium accurately predict the success of wide local excision for ductal carcinoma in situ surgery in our centre?

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Breast Cancer Research201315 (Suppl 1) :P22

  • Published:


  • Calcium
  • Carcinoma
  • Success Rate
  • Cancer Research
  • Powerful Predictor


A 2007 Nottingham paper suggests that a mammographic bidimensional product (BDP) of <800 mm2 calcification in high-grade ductal carcinoma in situ (DCIS) and <400 mm2 in low/intermediate DCIS is a powerful predictor of successful excision. We wanted to see whether their results were reproducible at our centre.


Eighty-four consecutive cases of DCIS over 18 months were reviewed and examined to determine the BDP of calcium (extent of mammographic calcification was measured in two orthogonal planes on the oblique view). Was reoperation required? Does the pathology report show clear margins? We excluded 15 patients that had a mastectomy (18%).


See Table 1.

Table 1


Successful WLE

Margins not clear

High-grade DCIS


   <800 mm2

15, 60% (Nottingham 69%)


   >800 mm2

2, 50% (Nottingham 24%)


Low-grade DCIS


   <400 mm2

24, 86% (Nottingham 73%)


   >400 mm2

9, 75% (Nottingham 33%)



We did not obtain similar results to the Nottingham paper. The success rate of WLE for low-grade DCIS was not (significantly) affected by BDP. Had BDP led to a recommendation not to perform WLE, the majority (75%) of women in this low-risk group, most at risk of overtreatment, would have had a mastectomy when conservative surgery would have succeeded. While we have not the large numbers of the Nottingham paper, we feel that in our centre at least, BDP of calcification seems not to be a practically useful predictor of excision success in nonhigh-grade DCIS.

Authors’ Affiliations

Plymouth Hospitals NHS Trust, Plymouth, UK


© Gray et al.; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.