Digital Mammography (DM) vs. Dynamic Contrast Enhancement-Magnetic Resonance Imaging (DCE-MRI) in Microcalcifications Assessment: A Radiological-Pathological Comparison

Abstract

The aim of this study was to compare the characteristics of breast microcalcification on digital mammography (DM) with the histological and molecular subtypes of breast cancer and to identify the predictive value of DM and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing microcalcifications for radiologic-pathologic correlation. We relied on our prospectively maintained database of suspicious microcalcifications on DM, from which data were retrospectively collected between January 2020 and April 2023. We enrolled 158 patients, all of whom were subjected to biopsy. Additionally, 63 patients underwent breast DCE-MRI. Microcalcifications with a linear branched morphology were correlated with malignancies (p < 0.001), among which an association was highlighted between triple negatives (TNs) and segmental distribution (p < 0.001). Amorphous calcifications were correlated with atypical ductal hyperplasia (ADH) (p = 0.013), coarse heterogeneous (p < 0.001), and fine-pleomorphic (p = 0.008) with atypical lobular hyperplasia (ALH) and fine pleomorphic (p = 0.009) with flat epithelial atypia (FEA). Regarding DCE-MRI, no statistical significance was observed between non-mass lesions and ductal carcinoma in situ (DCIS). Concerning mass lesions, three were identified as DCIS and five as invasive ductal carcinoma (IDC). In conclusion, microcalcifications assessed in DM exhibit promising predictive characteristics concerning breast lesion subtypes, leading to a reduction in diagnostic times and further examination costs, thereby enhancing the clinical management of patients.

Keywords: DCE-MRI; breast cancer; breast microcalcifications; digital mammography; radiologic–pathologic correlation.

Figure 1

A 48-year-old patient. DM examinations show a cluster of grouped microcalcifications at upper outer left breast (a,b). At DCE-MRI was observed non-mass enhancement with linear distribution at upper outer quadrant of left breast (c).

Figure 2

Patient enrollment flowchart.

Figure 3

A 35-year-old female with biopsy result B3—ADH. Mammography shows the presence of amorphous microcalcifications with regional distributions at the union of the lower quadrants (a,b). DCE-MRI shows linear heterogeneous non-mass enhancement (c,d).

Figure 4

A 48-year-old female with invasive ductal carcinoma, molecular subtype luminal B Her 2+. Mammography in the CC projections shows the presence of regionally distributed amorphous microcalcifications between the upper quadrants of the right breast (a,b). MRI of the same patient showed a heterogeneous non-mass enhancement with regional distribution in the post-contrast T1w sequences on the axial and sagittal planes (c,d). Biopsy under stereotaxic guidance of the microcalcifications and radiographic control of micro-histological specimens (e–g).