Presentation
Screening mammography. No familial history of breast cancer.
Patient Data
Fine pleomorphic and amorphous microcalcifications with regional and scattered distribution are seen in the upper outer quadrant of the right breast, which is moderately suspicious for malignancy (BI-RADS 4).
A mammographic-guided stereotactic core needle biopsy was performed for the right breast's suspicious microcalcifications, and the specimen x-ray shows the microcalcifications within. The histopathology evaluation confirmed invasive breast carcinoma of no special type.
Case Discussion
Suspicious breast calcifications, in general, tend to be smaller and less regular than typically benign calcifications and include:
coarse heterogeneous: irregular, generally 0.5-1 mm
amorphous: indistinct and/or small ("powdery", "cloud", or "cottony"), such that another specific shape cannot be determined
fine pleomorphic: variable shape ("shards of glass" or "crushed stone"), generally <0.5 mm
fine linear or fine-linear branching: thin (<0.5 mm), linear, branching or irregularly arranged ("casting")
Amorphous calcifications are usually suspicious (BI-RADS 4) unless they are bilateral and diffuse and/or stable for many years. A group of coarse heterogeneous, amorphous, or fine pleomorphic calcifications are moderately suspicious (BI-RADS 4B), whereas fine linear or fine-linear branching calcifications are highly suspicious (BI-RADS 4C).
In addition, if there is a combination of findings that is highly suggestive of malignancy (e.g. fine linear and branching calcifications in segmental distribution, or microcalcifications associated with a spiculated mass), then a BI-RADS 5 assessment may be appropriate.
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