A matrix of morphology and distribution of calcifications in the breast: Analysis of 849 vacuum-assisted biopsies

Kaltenbach, Benjamin; Brandenbusch, Volker; Möbus, V.; Mall, Gerhard; Falk, Stephan; Bergh, Marcus van den; Chevalier, Frauke; Müller-Schimpfle, Markus

doi:10.1016/j.ejrad.2016.11.022

Cited by 16 publications

(17 citation statements)

References 13 publications

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“…To categorize calcifications, their characteristics (e.g., amorphous, fine pleomorphic, or fine-linear branching) as well as their distribution in the breast (e.g., diffuse, regional, grouped, linear, and segmental) are taken into consideration. As shown by Müller-Schimpfle et al [11] and confirmed by Kaltenbach et al [12], combining both, the morphology and distribution characteristics of microcalcifications, leads to improved accuracy in estimating malignancy.…”

Section: Discussionmentioning

confidence: 87%

Stereotactic Vacuum-Assisted Breast Biopsy in Ductal Carcinoma in situ: Residual Microcalcifications and Intraoperative Findings

et al. 2019

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The question of overtreatment of ductal carcinoma in situ (DCIS) was raised because a significant proportion of especially low-grade DCIS lesions never progress to invasive cancer. The rationale for the present study was to analyze the value of stereotactic vacuum-assisted biopsy (VAB) for complete removal of DCIS, focusing on the relationship between the absence of residual microcalcifications after stereotactic VAB and the histopathological diagnosis of the definitive surgical specimen. Patients and Methods: Data of 58 consecutive patients diagnosed with DCIS by stereotactic VAB in a single breast center between 2012 and 2017 were analyzed. Patient records from the hospital information system were retrieved, and mammogram reports and images as well as histopathology reports were evaluated. The extent of microcalcifications before and after biopsy as well as the occurrence of DCIS in biopsy and definitive surgical specimens were analyzed and correlated. Results: There was no correlation between the absence of residual microcalcifications in the post-biopsy mammogram and the absence of residual DCIS in the final surgical specimen (p = 0.085). Upstaging to invasive cancer was recorded in 4 cases (13%) but occurred only in the group that had high-grade DCIS on biopsy. Lowgrade DCIS was never upgraded to high-grade DCIS in the definitive specimen. Conclusions: The radiological absence of microcalcifications after stereotactic biopsy does not rule out residual DCIS in the final surgical specimen. Since upstaging to invasive cancer is seen in a substantial proportion of high-grade DCIS, the surgical excision of high-grade DCIS should remain the treatment of choice.

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Section: Discussionmentioning

confidence: 87%

Stereotactic Vacuum-Assisted Breast Biopsy in Ductal Carcinoma in situ: Residual Microcalcifications and Intraoperative Findings

et al. 2019

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“…To further analyze the ALH calcification we developed a classification referring to previously published classifications of other types of soft tissue calcification [ 29 – 31 ]. By using three calcification patterns (single, spotted and streaky), we observed that streaky calcification is the pattern in ALH calcification with the highest mean amount of CC.…”

Section: Discussionmentioning

confidence: 99%

“…Based on previously published soft tissue classifications [ 29 – 31 ], the distribution of ALH calcification was categorized as three different patterns (singular, spotted or streaky) on DCR images (Fig. 1 ).…”

Section: Methodsmentioning

confidence: 99%

Calcification of the acetabular labrum of the hip: prevalence in the general population and relation to hip articular cartilage and fibrocartilage degeneration

et al. 2018

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BackgroundMeniscal calcification is considered to play a relevant role in the pathogenesis of osteoarthritis of the knee. Little is known about the biology of acetabular labral disease and its importance in hip pathology. Here, we analyze for the first time the calcification of the acetabular labrum of the hip (ALH) and its relation to hip cartilage degeneration.MethodsIn this cross-sectional post-mortem study of an unselected sample of the general population, 170 ALH specimens and 170 femoral heads from 85 donors (38 female, 47 male; mean age 62.1 years) were analyzed by high-resolution digital contact radiography (DCR) and histological degeneration grade. The medial menisci (MM) from the same 85 donors served as an intra-individual reference for cartilage calcification (CC). Scanning electron microscopy (SEM), energy dispersive analysis (ED) and Raman spectroscopy were performed for characterization of ALH CC.ResultsThe prevalence of CC in the ALH was 100% and that in the articular cartilage of the hip (ACH) was 96.5%. Quantitative analysis revealed that the amount of ALH CC was higher than that in the ACH (factor 3.0, p < 0.001) and in the MM (factor 1.3, p < 0.001). There was significant correlation between the amount of CC in the fibrocartilage of the left and right ALH (r = 0.70, p < 0.001). Independent of age, the amount of ALH CC correlated with histological degeneration of the ALH (Krenn score) (r = 0.55; p < 0.001) and the ACH (Osteoarthritis Research Society International (OARSI), r = 0.69; p < 0.001). Calcification of the ALH was characterized as calcium pyrophosphate dihydrate deposition.ConclusionThe finding that ALH fibrocartilage is a strongly calcifying tissue is unexpected and novel. The fact that ALH calcification correlates with cartilage degeneration independent of age is suggestive of an important role of ALH calcification in osteoarthritis of the hip and renders it a potential target for the prevention and treatment of hip joint degeneration.

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“…All cases of category 3 calcification based on the scoring system were benign in both datasets. Beyond the guidelines suggested by prior studies, our scoring system provides stratified recommendations from category 3 through category 5 assessment including category 4 subdivisions by combining every morphology or distribution descriptor (2313). Fine linear or linear branching calcifications with linear or segmental distributions can be included in category 5 in our scoring system with a score ≥ 5.5 and a PPV of 100% and 95% in our and validation dataset, respectively (Tables 3, 4).…”

Section: Discussionmentioning

confidence: 99%

Scoring System to Stratify Malignancy Risks for Mammographic Microcalcifications Based on Breast Imaging Reporting and Data System 5th Edition Descriptors

et al. 2019

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ObjectiveTo develop a scoring system stratifying the malignancy risk of mammographic microcalcifications using the 5th edition of the Breast Imaging Reporting and Data System (BI-RADS).Materials and MethodsOne hundred ninety-four lesions with microcalcifications for which surgical excision was performed were independently reviewed by two radiologists according to the 5th edition of BI-RADS. Each category's positive predictive value (PPV) was calculated and a scoring system was developed using multivariate logistic regression. The scores for benign and malignant lesions or BI-RADS categories were compared using an independent t test or by ANOVA. The area under the receiver operating characteristic curve (AUROC) was assessed to determine the discriminatory ability of the scoring system. Our scoring system was validated using an external dataset.ResultsAfter excision, 69 lesions were malignant (36%). The PPV of BI-RADS descriptors and categories for calcification showed significant differences. Using the developed scoring system, mean scores for benign and malignant lesions or BI-RADS categories were significantly different (p < 0.001). The AUROC of our scoring system was 0.874 (95% confidence interval, 0.840–0.909) and the PPV of each BI-RADS category determined by the scoring system was as follows: category 3 (0%), 4A (6.8%), 4B (19.0%), 4C (68.2%), and 5 (100%). The validation set showed an AUROC of 0.905 and PPVs of 0%, 8.3%, 11.9%, 68.3%, and 94.7% for categories 3, 4A, 4B, 4C, and 5, respectively.ConclusionA scoring system based on BI-RADS morphology and distribution descriptors could be used to stratify the malignancy risk of mammographic microcalcifications.

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A matrix of morphology and distribution of calcifications in the breast: Analysis of 849 vacuum-assisted biopsies

Cited by 16 publications

References 13 publications

Stereotactic Vacuum-Assisted Breast Biopsy in Ductal Carcinoma in situ: Residual Microcalcifications and Intraoperative Findings

Stereotactic Vacuum-Assisted Breast Biopsy in Ductal Carcinoma in situ: Residual Microcalcifications and Intraoperative Findings

Calcification of the acetabular labrum of the hip: prevalence in the general population and relation to hip articular cartilage and fibrocartilage degeneration

Scoring System to Stratify Malignancy Risks for Mammographic Microcalcifications Based on Breast Imaging Reporting and Data System 5th Edition Descriptors

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