Amorphous calcifications (breast)
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Amorphous calcifications, previously known as indistinct calcifications, are a morphological descriptor for breast calcifications that are small and/or hazy such that no clearly defined shape/form can be ascribed.
Many benign and malignant conditions may be seen in association with these calcifications 1.
- benign: ~60%
- high risk lesions: ~20%
- malignant: ~20% 1-2
Magnification views as part of a diagnostic mammographic evaluation are required to fully assess these calcifications.
Amorphous calcifications are small (80-200 micrometer in diameter) and/or hazy/faint, such that a more specific morphologic descriptor cannot be assigned.
Given the 20% positive predictive value of malignancy, most amorphous calcifications are assessed as BI-RADS 4B (suspicious, warranting biopsy) 5. That assessment particularly applies to amorphous calcifications with a grouped, linear, or segmental distribution. However, bilateral diffuse amorphous calcifications may be assessed as BI-RADS 2 (benign). If long-term (2-3 year) stability has been demonstrated, a BI-RADS 2 assessment would also be appropriate.
If the interpreting radiologist has sufficient personal experience with this finding to suggest <2% risk of malignancy to justify a watchful waiting approach, a BI-RADS 3 assessment may be entertained, but this approach is not supported by the literature 5.
- 1. Berg W, Arnoldus C, Teferra E, Bhargavan M. Biopsy of Amorphous Breast Calcifications: Pathologic Outcome and Yield at Stereotactic Biopsy. Radiology. 2001;221(2):495-503. doi:10.1148/radiol.2212010164 [Pubmed]
- 2. Hall F. Computer-Aided Detection (CAD) of Amorphous Calcifications. AJR Am J Roentgenol. 2006;186(3):902; author reply 902-3. doi:10.2214/ajr.06.5013 [Pubmed]
- 3. Soo M, Rosen E, Xia J, Ghate S, Baker J. Computer-Aided Detection of Amorphous Calcifications. AJR Am J Roentgenol. 2005;184(3):887-92. doi:10.2214/ajr.184.3.01840887 [Pubmed]
- 4. Ellen Shaw De Paredes. Atlas of Mammography. (2007) ISBN: 0781764335
- 5. Acr. ACR BI-RADS Atlas. (2013) ISBN: 155903016X