Suspicious calcifications in BI-RADS 4 and 5 breast lesions: Digital mammographic-pathologic correlation

Abstract

Background : The calcifications are commonly observed in mammographic feature of breast cancer. The assessment of combined descriptors of calcification may help predict the risk of malignancy.

Objective : To study the correlation and assess the accuracy of suspicious calcifications in BI-RADS 4 and 5 detected on digital mammography and pathology.

Design : Retrospective review

Material and Methods : Of 176 breasts with suspicious calcifications in BI-RADS 4 and 5 were reviewed the descriptors for morphology, distribution and other associated findings by using final category assessment by BI-RADS 5th edition. The definition was compared with histopathology from core needle biopsy or surgery.

Setting : Department of Radiology, King Chulalongkorn Memorial Hospital.

Results : Forty-five benign (25.6%) and 131 malignant (74.4%) of 176 breast calcifications were confirmed. The positive predictive value (PPV) for malignancy according to BI-RADS were as follows: category 4A, 13/36 (36.1%); category 4B, 22/39 (56.4%); category 4C, 27/30 (90%) and category 5, 69/71(96.2%). PPVs for malignancy significantly increased in morphologic descriptors including amorphous, coarse heterogeneous, fine pleomorphic and fine linear descriptors were 51.7%, 81.2%, 84.6% and 91.4%, respectively. PPVs of distribution descriptors were 70.5% (79/112) of the cluster, 75% (6/8) of the regional, 76.5% (26/34) of the segmental and 90.9% (20/22) of the linear distribution.

Conclusion : Morphologic descriptors of suspicious calcifications were statistically significant increasing the risk of malignancy. The most and second most common PPVs of morphologic descriptors were fine linear and fine pleomorphic descriptors, respectively. The highest PPV of distribution descriptor was linear distribution.