Suspicious amorphous microcalcifications detected on full-field digital mammography: correlation with histopathology

Abstract

ObjectiveTo evaluate suspicious amorphous calcifications diagnosed on full-field digital mammography (FFDM) and establish correlations with histopathology findings.Materials and MethodsThis was a retrospective study of 78 suspicious amorphous calcifications (all classified as BI-RADS® 4) detected on FFDM. Vacuum-assisted breast biopsy (VABB) was performed. The histopathological classification of VABB core samples was as follows: pB2 (benign); pB3 (uncertain malignant potential); pB4 (suspicion of malignancy); and pB5 (malignant). Treatment was recommended for pB5 lesions. To rule out malignancy, surgical excision was recommended for pB3 and pB4 lesions. Patients not submitted to surgery were followed for at least 6 months.ResultsAmong the 78 amorphous calcifications evaluated, the histopathological analysis indicated that 8 (10.3%) were malignant/suspicious (6 classified as pB5 and 2 classified as pB4) and 36 (46.2%) were benign (classified as pB2). The remaining 34 lesions (43.6%) were classified as pB3: 33.3% were precursor lesions (atypical ductal hyperplasia, lobular neoplasia, or flat epithelial atypia) and 10.3% were high-risk lesions. For the pB3 lesions, the underestimation rate was zero.ConclusionThe diagnosis of precursor lesions (excluding atypical ductal hyperplasia, which can be pB4 depending on the severity and extent of the lesion) should not necessarily be considered indicative of underestimation of malignancy. Suspicious amorphous calcifications correlated more often with precursor lesions than with malignant lesions, at a ratio of 3:1.

Diagnostic Performance of Digital Breast Tomosynthesis for Breast Suspicious Calcifications From Various Populations: A Comparison With Full-field Digital Mammography

“…Whereas, for malignant cases, a significant difference was not observed. The malignancy rates reported in the previous literatures ranged from 10% (8/78) to 39% (41/105) [ [31] , [32] , [33] ], which was consistent with our result. In our study, 98 (31%) sites of suspicious calcifications were proved malignant and 214 (69%) were benign.…”

Comprehensive quantitative malignant risk prediction of pure grouped amorphous calcifications: clinico-mammographic nomogram

“…Age and menopausal status have always been important risk factors for the benign and malignant calcifications of the breast, which have been distinguished in BI-RADS category 4 calcifications (14) and amorphous calcifications (4). In this study, age group and menopausal status were also found to be malignancy risk factors, and elderly women (aged ≥60 years) had a higher malignancy rate than younger women, which is consistent with the literature on amorphous calcifications (4,23).…”

Amorphous breast calcifications: is BI-RADS 4a appropriate?

“…Similar PPV values—7.9%, 7.1%, 10.3%, and 10.5%—were reported, respectively, by Kim et al. ( 6 ) , Metaxa et al ( 7 ) , Oligane et al ( 2 ) , and Ferreira et al ( 8 ) . This risk stratification brings amorphous calcifications closer to BI-RADS category 4a than category 4b (as currently suggested).…”

“…Although the rate of detection of amorphous calcifications has increased with the use of digital mammography and specific medical monitors, the management of this subgroup of calcifications can be challenging. It is not uncommon for amorphous calcifications to be identified only on magnified images, in only one view, or even not defined in the stereotactic window on stereotaxic devices or tables, making it impossible to perform percutaneous biopsy or the preoperative marking process ( 4 , 5 , 6 , 7 , 8 , 9 ) .…”