Are punctate/clustered breast calcifications highly pathognomic for malignant process?
Yes
A predominantly hypodense, homogeneously mid-level echo-filled and walled-off, relatively well defined unilocular fluid content (<10 ml) with central posterior acoustic enhancement plus subtle lateral edge shadowing is noted within the left breast intramammary region at the upper inner quadrant 10:00 clock position. Accompanying hyper-reflective and posteriorly shadowing punctate calcific foci of sub-centimetre dimensions are chanced as well intrinsically within the mentioned fluid content (more within the internal lateral wall aspects). No overt regional desmoplastic tissue reaction or subcutaneous tissue oedema or hypervascularity or axillary lymphadenopathy was noted.
A conspicuously tiny and diffusely hypoechoic lesion (of less than 1 cm in diameter) with indistinct outer margins is visualized ipsilaterally adjacent and extrinsic to the left breast fluid content (aforementioned) and these sonographic features point more in the direction of cold left breast abscess likely primarily attributable to partial intra-ductal obstruction sequelae of early/low-grade ductal carcinoma changes (BIRAD 4c - moderate suspicion for malignancy).