Breast calcifications (an approach)
An approach to breast calcifications in terms of imaging evaluation and biopsy aims to distinguish benign from malignant etiologies. This article overviews a general approach to the evaluation of breast calcifications. The types and descriptors of calcifications are detailed separately: breast calcifications.
Radiographic appearance
Morphology
-
suspicious
- fine linear or fine-linear branching
- fine pleomorphic
- amorphous
- coarse heterogeneous
- indeterminate
-
typically benign
- skin
- vascular
- coarse or "popcorn-like"
- large rod-like
- round
- rim (historically "eggshell")
- dystrophic
- milk of calcium
- suture
Distribution
-
suspicious
- segmental
- linear
-
indeterminate
- grouped
- regional
-
typically benign
- diffuse
Size
Small calcifications (<200 μm in diameter) are mostly malignant.
Stability
Calcifications stable for greater than 2 years can be considered benign.
Number
The greater the number of microcalcifications in a small area, the more suspicious for malignancy.
Management
Screening mammography
At screening mammography, comparison should be made with prior studies to establish benignity through long term stability (at least 2 years) if possible. Calcifications identified on screening mammography that do not clearly appear benign should be recalled (BI-RADS 0).
Diagnostic mammography
At diagnostic mammography, additional views with magnification should be performed to confirm the morphology and number of calcifications.
Short interval followup
An isolated group of punctate calcifications at baseline evaluation can be designated probably benign (BI-RADS 3), for which short interval followup mammography is appropriate 6.
Other types of calcifications may be categorized as probably benign (BI-RADS 3) if the radiologist has personal experience justifying a watchful waiting approach, but these approaches are not supported by substantial evidence 7:
- developing calcifications that are most likely, but are not definitely, vascular
- calcifications suggestive of early evolving fat necrosis
Ultrasound
For suspicious calcifications, a focused ultrasound is reasonable to evaluate for a mammographically occult abnormality such as a mass. Calcifications can sometimes be redemonstrated on ultrasound as well, providing another option for image-guided biopsy.
Biopsy
Core needle biopsy of suspicious calcifications should be performed (BI-RADS 4 or 5) with image guidance using the available modality that best demonstrated the findings, which often means stereotactic or digital breast tomosynthesis-guided biopsy 8. Specimen radiographs should be obtained to confirm adequate sampling of the calcifications. Especially in the case of ultrasound-guided or MRI-guided biopsy, a biopsy marker should be deposited so that the correct biopsy site can be confirmed on post-biopsy mammography.
If no calcifications are identified at histology, the entire paraffin block can be radiographed and further sections obtained if there are indeed calcifications present 9.
Related Radiopaedia articles
Breast imaging and pathology
- breast screening
-
mammography
- breast imaging and the technologist
- forbidden (check) areas in mammography
-
mammography views
- craniocaudal view
- mediolateral oblique view
- additional (supplementary) views
- true lateral view
- lateromedial oblique view
- late mediolateral view
- step oblique views
- spot view
- double spot compression view
- magnification view
- exaggerated craniocaudal (axillary) view
- cleavage view
- tangential views
- caudocranial view
- bullseye CC view
- rolled CC view
- elevated craniocaudal projection
- caudal cranial projection
- 20° oblique projection
- inferomedial superolateral oblique projection
- Eklund technique
- normal breast imaging examples
- digital breast tomosynthesis
- breast ultrasound
- breast ductography
- breast MRI
- breast morphology
- breast pathology
- malignant lesions
-
breast cancer
- breast adenocarcinoma
- ductal breast carcinoma
- ductal carcinoma in situ (DCIS)
- invasive ductal carcinoma
- lobular breast carcinoma
- ductal breast carcinoma
- adenoid cystic carcinoma of the breast
- apocrine carcinoma of the breast
- breast cancer metastases
- breast lymphoma
- breast sarcoma
- inflammatory carcinoma of breast
- intracystic breast cancer
- male breast cancer
- malignant phyllodes tumor
- metastases to the breast
- metaplastic carcinoma the breast
- gamuts
- breast adenocarcinoma
-
breast cancer
- borderline breast disease / high risk breast lesion
- benign lesions
- adenosis of the breast
- benign papillary lesions of the breast
- breast cyst
- breast hematoma
- breast hamartoma
- breast lipoma
- ductal adenoma of the breast
- epidermal inclusion cysts of the breast
- fat necrosis of the breast
- fibroadenoma
- granular cell tumor of the breast
- gynecomastia
- lymphocytic mastitis
- mammary fibromatosis
- oil cyst
- phyllodes tumor
- post-surgical breast scar
- post-radiation breast changes
- post-traumatic fibrosis
- pseudoangiomatous stromal hyperplasia (PASH)
- pseudogynecomastia
- tubular adenoma
-
breast calcifications (approach)
- morphology
- distribution
- location
- lobular calcification within breast tissue
- intraductal calcification within breast tissue
- milk of calcium within a breast cyst
- vascular calcification in breast tissue
- skin (dermal) calcification in / around breast tissue
- suture calcification within breast tissue
- stromal calcification within breast tissue
- artifactual calcification from outside the breast
- suspicious breast calcifications
- infection/inflammation
- vascular lesions
- systemic disease
- gamuts
- classification systems
- malignant lesions
- breast cancer staging
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