Breast calcifications (an approach)

Breast calcifications are relatively frequent on mammograms and are indicative of focally active process, however about 80% of these processes are benign. Thus the ability to distinguish these calcifications based on their morphological characteristics, size, number and distribution is important, and on follow-up mammograms the stability of the lesions should be determined.

Morphology

• probably malignant (probably intraductal)
  • irregular
  • pleomorphic
  • fine, linear, branching 
  • amorphous microcalcification 
  • irregular or jagged edges
• indeterminate calcification
  • amorphous microcalcification  
  • indistinct, granular microcalcification
• probably benign (probably intralobular)
  • round, smooth 
  • punctate microcalcifications 
  • coarse calcification
  • lucent centred calcification
  • egg shell calcification
  • dystrophic calcification 
  • skin calcification
  • large rod like
  • milk of calcium
  • vascular calcification
  • sutural calcification

Distribution

• probably malignant
  • grouped clusters 
  • segmental distribution
  • linear distribution 

Size

Small calcifications (<200 μm in diameter) are mostly malignant.

Stability   

Calcifications stable for greater than 2 years are in favour of a benign etiology.

Number

The greater the number of microcalcifications in an area, the more suspicious for malignancy. Malignant calcifications tend to occur in clusters of an area ¾-1 cm.

Multiplicity

Malignancy can be multifocal, hence the entire breast should be screened to rule out multicentric disease.