Benign Breast Calcifications

Excerpt

Breast calcifications are extremely common. It is important to be able to differentiate between benign and malignant calcifications because approximately half of all non-palpable breast cancers are associated with calcifications. Proper identification of benign calcifications as such can avoid unnecessary intervention and use of finite resources.

The Breast Imaging Reporting and Data System (BI-RADS) lexicon, the standardized method of conveying mammographic findings as developed by the American College of Radiology, separates calcifications into “typically benign” and “suspicious morphology” categories. This article will discuss the typically benign calcifications. Because calcifications are most readily identifiable mammographically, as opposed to on MRI or ultrasound on which susceptibility artifact and posterior shadowing obscure the details of calcification morphology, the discussion to follow will be in the context of mammography unless otherwise stated.

The standard approach to calcifications outlines the type/shape of calcification and the distribution within the breast. Skin, vascular, coarse or popcorn-like, large rod-like, round, rim, dystrophic, milk of calcium, and suture calcifications comprise the “typically benign” category. After calcifications have been identified, a description of the distribution of calcifications should be applied. Diffuse, regional, grouped, linear, and segmental are the available standard descriptors for conveying the distribution of calcifications. Calcifications in a diffuse distribution, especially when bilateral, are almost always benign. The remaining categories for describing distribution are associated with varying degrees of positive predictability of breast cancer, which is beyond the scope of this article.