The role of mammographic findings associated with breast microcalcifications in the choice of imaging tactics

Authors

DOI:

https://doi.org/10.18370/2309-4117.2025.76.46-50

Keywords:

breast, full-field digital mammography, microcalcifications, calcifications, breast cancer, architectural distortion, breast asymmetry, ultrasound

Abstract

ackground. Calcifications are considered the most common mammography findings, detected in 80% of cases. Although the majority of calcifications are not dangerous and represent benign changes that do not require further examination and follow-up, in one third of cases, suspicious microcalcifications (MC) are verified as malignant. In addition, MC can be identified with associated findings such as architectural distortions, asymmetries, and masses, which can further complicate imaging interpretation.
Objective of the study: to evaluate the impact of concomitant findings associated with MC on the risk of breast cancer detection.
Materials and methods. An analysis of radiological and pathomorphological studies was carried out in 129 women with suspicious MC, aged from 31 to 85 years, with an average age of 49.0 years. Sampling was performed under ultrasound and X-ray guidance, depending on the ability to visualize the suspicious area with MC.
Results. MC with associated findings (19.38%) increase the risk of detecting malignant pathology at the verification stages in comparison with suspicious MC without associated findings
(8.53%). The probability of detecting an invasive component increases, which is further confirmed by the increased frequency of visualization of these associated findings on ultrasound (18.6%) compared to the women without associated findings (6.2%), and the frequency of breast complaints in female patients. The most frequent and dangerous concomitant findings were masses (39.28%) and architectural distortions (42.85%). The probability of detecting concomitant findings associated with MC increased when visualizing suspicious MC in the upper-outer quadrant, when the size of the MC area was more than 15 mm and in the age group of elderly and geriatric patients (p < 0.05).
Conclusions. Whenever possible, physicians should immediately verify suspicious areas associated with MC. Particular attention should be paid to masses and architectural distortions associated with MC. Risks of associated findings may include the size of the MC area > 15 mm, localization in the upper-outer quadrant of the breast, and the elderly and geriatric patients.

Author Biographies

A.Y. Kovtun, Shupyk National Healthcare University of Ukraine, Kyiv

radiologist, Medical Center “Verum Expert Clinic”, postgraduate student, Radiology Department

T.M. Kozarenko, Shupyk National Healthcare University of Ukraine, Kyiv

PhD, professor, head of the Radiology Department

A.V. Gurando, Shupyk National Healthcare University of Ukraine, Kyiv

PhD, assistant, Radiology Department

References

  1. Fedorenko ZP, Sumkina OV, Gorokh EL, et al. Cancer in Ukraine, 2022–2023. Incidence, mortality, performance indicators of the oncology service. [Internet]. Bulletin of the National Cancer Registry of Ukraine 25. Kyiv: National Cancer Institute; 2024. Available from: http://www. ncru.inf.ua/publications/BULL_25/PDF/BULL_25.pdf.
  2. Breast Cancer. [Internet]. World Health Organization, 2024 March 13. [accessed 20 Jun 2024]. Available from: https://www.who.int/news-room/fact-sheets/detail/breast-cancer
  3. Sickles EA, D’Orsi CJ, Bassett LW, et al. ACR BI-RADS® Mammography. ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology; 2013. 39–136 рр.
  4. Berg WA, Leung JWT. Diagnostic Imaging: Breast, 3rd Edition. Philadelphia, PA, Elsevier; 2019, p. 246–390.
  5. Logullo AF, Prigenzi KCK, Nimir CCBA, et al. Breast microcalcifications: Past, present and future (Review). Mol Clin Oncol. 2022 Apr;16(4):81. DOI: 10.3892/mco.2022.2514.
  6. Nyante SJ, Lee SS, Benefield TS, Hoots TN., et al. The association between mammographic calcifications and breast cancer prognostic factors in a population-based registry cohort. Cancer. 2017 Jan 1;123(2):219–27. DOI: 10.1002/cncr.30281.
  7. Månsson E, Bergkvist L, Christenson G, et al. Mammographic casting-type calcifications is not a prognostic factor in unifocal small invasive breast cancer: a population-based retrospective cohort study. J Surg Oncol. 2009 Dec 15;100(8):670–4. DOI: 10.1002/jso.21405.
  8. Bansal GJ, Emanuel L, Kanagasabai S. Malignancy risk of indeterminate mammographic calcification in symptomatic breast clinics. Postgrad Med J. 2023 May 19;99(1169):153–8. DOI: 10.1136/postgradmedj-2021-140835.
  9. Henrot P, Leroux A, Barlier C, Génin P. Breast microcalcifications: the lesions in anatomical pathology. Diagn Interv Imaging. 2014 Feb;95(2):141–52. DOI: 10.1016/j.diii.2013.12.011.
  10. Brennan ME, Turner RM, Ciatto S, et al. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology. 2011 Jul;260(1):119–28. DOi: 10.1148/radiol.11102368.
  11. Sickles EA. The spectrum of breast asymmetries: imaging features, work-up, management. Radiol Clin North Am. 2007 Sep;45(5):765–71. DOi: 10.1016/j.rcl.2007.06.002.
  12. Samreen N, Moy L, Lee CS. Architectural Distortion on Digital Breast Tomosynthesis: Management Algorithm and Pathological Outcome. J Breast Imaging. 2020 Sep 24;2(5):424–35. DOI: 10.1093/jbi/wbaa034.
  13. Goh Y, Chan CW, Pillay P, et al. Architecture distortion score (ADS) in malignancy risk stratification of architecture distortion on contrast-enhanced digital mammography. Eur Radiol. 2021 May;31(5):2657–66. DOI: 10.1007/s00330-020-07395-3.
  14. Gaur S, Dialani V, Slanetz PJ, et al. Architectural distortion of the breast. AJR Am J Roentgenol. 2013 Nov;201(5):W662–70. DOI: 10.2214/AJR.12.10153.
  15. Shin HJ, Kim HH, Huh MO, et al. Correlation between mammographic and sonographic findings and prognostic factors in patients with node-negative invasive breast cancer. Br J Radiol. 2011 Jan;84(997):19–30. DOІ: 10.1259/bjr/92960562.
  16. Lee H, Kim SH, Kang BJ, et al. Clinical Utility of MicroPure US Imaging for Breast Microcalcifications. J Korean Soc Radiol. 2022 Jul;83(4):876–86. DOІ: 10.3348/jksr.2021.0082.
  17. Hadadi I, Rae W, Clarke J, et al. Diagnostic Performance of Adjunctive Imaging Modalities Compared to Mammography Alone in Women with Non-Dense and Dense Breasts: A Systematic Review and Meta-Analysis. Clin Breast Cancer. 2021 Aug;21(4):278–91. DOI: 10.1016/j.clbc.2021.03.006
  18. Romeih M, Raafat TA, Ahmed G, et al. Value of digital breast tomosynthesis in characterization of breast lesions in dense breast. Egypt J Radiol Nucl Med 55, 131 (2024). DOI: 10.1186/s43055-024-01298-9
  19. Tot T, Gere M, Hofmeyer S, et al. The clinical value of detecting microcalcifications on a mammogram. Semin Cancer Biol. 2021 Jul:72:165–74. DOi:10.1016/j.semcancer.2019.10.024
  20. Tian Y, Zhao L, Gui Z, et al. Clinical and pathological features analysis of invasive breast cancer with microcalcification. Cancer Med. 2023 May;12(10):11351–62. DOI: 10.1002/cam4.5848.
  21. Kim J, Kim EK, Kim, MJ, et al. “Category 4A” microcalcifications: how should this subcategory be applied to microcalcifications seen on mammography? Acta Radiologica. 59.2 (2018):147–53.
  22. Fushimi A, Fukushima N, Suzuki T, et al. Features of Microcalcifications on Screening Mammography in Young Women. Asian Pac J Cancer Prev. 2018 Dec 25;19(12):3591–6. DOi: 10.31557/APJCP.2018.19.12.3591.
  23. Kim S, Tran TXM., Song H, et al. Microcalcifications, mammographic breast density, and risk of breast cancer: a cohort study. Breast Cancer Res. 2022 Dec 21;24(1):96. DOI: 10.1186/s13058-022-01594-0
  24. Shiovitz S, Korde LA. Genetics of breast cancer: a topic in evolution. Ann Oncol. 2015 Jul;26(7):1291–9. DOI: 10.1093/annonc/mdv022.
  25. Shah A, Haider G, Abro N, et al. Correlation Between Site and Stage of Breast Cancer in Women. Cureus. 2022 Feb 27;14(2):e22672. DOI: 10.7759/cureus.22672.

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Published

2025-03-31

How to Cite

Kovtun, A., Kozarenko, T., & Gurando, A. (2025). The role of mammographic findings associated with breast microcalcifications in the choice of imaging tactics. REPRODUCTIVE ENDOCRINOLOGY, (76), 46–50. https://doi.org/10.18370/2309-4117.2025.76.46-50

Issue

No. 76 (2025)

Section

Mammology

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