Malignancy Risk Stratification Prediction of Amorphous Calcifications Based on Clinical and Mammographic Features

Abstract

To explore the potential factors influencing the malignancy risk of amorphous calcifications and establish a predictive nomogram for malignancy risk stratification. Patients and Methods: Consecutive mammograms from January 2013 to December 2018 were retrospectively reviewed. Traditional clinical features were recorded, and mammographic features were estimated according to the 5th BI-RADS. Included calcifications were randomly divided into the training and validation cohorts. A nomogram was developed to graphically predict the risk of malignancy (risk) based on stepwise multivariate logistic regression analysis. The discrimination and calibration performance of the model were assessed in both the training and validation cohorts. Results: Finally, 1018 amorphous calcifications with final pathological results in 907 women were identified with a malignancy rate of 28.4% (95% CI: 25.7%, 31.3%). The malignancy rates of subgroups divided by the distribution of calcifications, quantity of calcifications, age, menopausal status and family history of cancer were significantly different. There were 712 cases and 306 cases in the training and validation cohorts. The prediction nomogram was finally developed based on four risk factors, including age and distribution, maximum diameter and quantity of calcifications. The AUC of the nomogram was 0.799 (95% CI: 0.761, 0.836) in the training cohort and 0.795 (95% CI: 0.738, 0.852) in the validation cohort. Conclusion: On mammography, the distribution, maximum diameter and quantity of calcifications are independent predictors of malignant amorphous calcifications and can be easily obtained in the clinic. The nomogram developed in this study for individualized malignancy risk stratification of amorphous calcifications shows good discrimination performance.

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

“…Many factors affect the PPV of calcifications, including the distribution, morphology, patient age/ menopausal status, whether the mammogram was for screening or diagnostic purposes, and history of breast or ovarian cancer (2)(3)(4)(5)(6)(7)(8)(9)(10)14,15). We also found that the malignancy rate of grouped amorphous calcifications was lower than other calcification distributions in our previous study (16). However, to date, very few studies have focused on the assessment of pure grouped amorphous calcifications.…”

Grouped Amorphous Microcalcifications on Mammography: A Single-Centre 8-Year Retrospective Cohort Study on an Asian Population

“…In recent years, screening programmes advocate a high call-back biopsy rate, arousing controversies on the acceptable malignancy risk and critics on unnecessary biopsies and misallocated healthcare resources. 2,3,6 Apart from recent evidence supporting a lower BI-RADS subcategory as discussed above, the majority of the malignancies come back as DCIS, which is known to carry a high survival rate after surgical and optional adjuvant treatments. 2,3 This is also coherent with our results, with 80% (n = 4) of malignant cases being DCIS.…”