Breast calcifications

Dr Owen Kang and Radswiki et al.

Breast calcifications can arise from a vast number of aetiologies. 

They are extremely common and can be present in ~85% of mammograms 8. Their frequency increases with age. Up to 50% of breast cancers can be associated with calcification while 15-30% of calcifications biopsied for various reasons tend to be malignant in asymptomatic patients 10.

Calcification can comprise of:

  • calcium phosphate salt deposition: stains purple on routine H&E stain
  • calcium oxalate salt deposition: can be difficult to visualise on H&E stain, requires the use of polarized light to assess birefringence
Classification

Breast microcalcifications can be grouped according to location, distribution, morphology or underlying aetiology. 

Location
Distribution
Morphology
Underlying aetiology

If microcalcifications are distributed in a segment of the breast they deserve special attention. Calcifications running from the nipple posteriorly in a breast segment is a potentially sinister sign and the possibility of DCIS involving a whole breast segment should be kept in mind. See case 18966.

There are two main reasons why calcifications are potentially significant:

1. A percentage of breast malignancies present as microcalcifications before they present as a mass. The prime example is DCIS, a non-obligate precursor of infiltrating ductal carcinoma. In the days before senology was accepted as a diagnostic technique, the diagnosis of breast cancer was made after the patient presented with a mass or metastases or post mortem. Depending on which reference you use, the incidence of DCIS in large screening series is around 30%. Coincidentally, this is also the rate of decreased mortality attributed to screening in the literature.

2. The second reason breast calcifications are important is the science involved to be able to diagnose and manage and distinguish significant microcalcifications from insignificant ones. The ability to diagnose and appropriately manage the significant microcalcifications and differentiate them from innocuous findings is part of the art of breast imaging.

The ability to diagnose a malignancy early implies that the disease is potentially curable with less chance of metastatic disease and with potentially less invasive surgery. Coupled with improvements in therapy, this shows why regular screening mammography results in more people surviving.

For the novice, the interpretation and approach to breast calcifications can be intimidating. An approach is to use reference 12 below. The book is readable in a weekend and gives a morphological atlas as well as differential diagnosis to the most commonly encountered calcifications in the breast. The illustrations are good and representative and serve as a good guide. The breast section of this site contains a wide variety of cases to review.

Breast imaging and pathology
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Article Information

rID: 13952
System: Breast
Section: Gamuts
Tag: rewrite
Synonyms or Alternate Spellings:
  • Breast calcification
  • Calcifications within breast tissue
  • Calcification within breast tissue

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Cases and Figures

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    Case 1: vascular calcification
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    Case 2: microcalcification - histology unknown
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    Involuted fibroad...
    Case 3: popcorn calcification - involuted fibroadenoma
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    skin calcificatio...
    Case 4: skin calcifications in the left areola region
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