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.
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Pathology
Many benign and malignant conditions may be seen in association with these calcifications 1.
- benign: ~60%
- high risk lesions: ~20%
- malignant: ~20% 1-2
- low grade ductal carcinoma in situ (DCIS)
- invasive ductal carcinoma ~10%: usually has an accompanying mass
Radiographic features
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.
Radiology report
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.
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