Association Between Microcalcification Patterns in Mammography and Breast Tumors in Comparison to Histopathological Examinations

Abstract

Background/Objectives: Accurately correlating mammographic findings with corresponding histopathologic features is considered one of the essential aspects of mammographic evaluation, guiding the next steps in cancer management and preventing overdiagnosis. The objective of this study was to evaluate patterns of mammographic microcalcifications and their association with histopathological findings related to various breast tumors. Methods: 110 out of 3603 women had microcalcification of BIRADS 3 or higher and were subjected to stereotactic/ultrasound (USG) guided biopsies, and hook-wire localization excision procedures. Ultrasound and mammography images were reviewed by experienced radiologists using the standard American College of Radiology Breast-Imaging Reporting and Data System (ACR BI-RADS). Results: Our study showed that features with a high positive predictive value (PPV) of breast malignancy were heterogeneous (75%), fine linear/branching pleomorphic microcalcifications (66.7%), linear (100%), and segmental distributions (57.1%). Features that showed a higher risk of association with ductal carcinoma in situ (DCIS) were fine linear/branching pleomorphic (odds ratio (OR): 3.952), heterogeneous microcalcifications (OR: 3.818), segmental (OR: 5.533), linear (OR: 3.696), and regional (OR: 2.929) distributions. Furthermore, the features with higher risks associated with invasive carcinoma had heterogeneous (OR: 2.022), fine linear/branching pleomorphic (OR: 1.187) microcalcifications, linear (OR: 6.2), and regional (OR: 2.543) distributions. The features of associated masses in mammograms that showed a high PPV of malignancy had high density (75%), microlobulation (100%), and spiculated margins (75%). Conclusions: We concluded that specific patterns and distributions of microcalcifications were indeed associated with a higher risk of malignancy. Those with fine linear or branching pleomorphic and segmental distribution were at a higher risk of DCIS, whereas those with heterogeneous morphology with a linear distribution were at a higher risk of invasive carcinoma.

Keywords: breast malignancy; ductal carcinoma in situ; histopathology; invasive carcinoma; mammogram; mass; microcalcifications.

Figure 1

Sample distribution.

Figure 2

Mammogram study of a left breast in (A) mediolateral (MLO) view and (B) craniocaudal (CC) view, showing amorphous calcifications in a segmental distribution in the upper outer quadrant, reported as a BI-RADS 4 lesion. Given these calcifications, a stereotactic-guided core biopsy was performed; the HPE showed DCIS. There were also benign coarse calcifications in the upper outer and mid-inner quadrants.

Figure 3

Mammogram study of a left breast in (A) MLO view and (B) CC view, showing a group of pleomorphic calcifications in the upper mid-quadrant (arrow), reported as BI-RADS 4 lesion. These calcifications were HPE-proven DCIS. There were also benign coarse calcifications in the upper inner quadrant.

Figure 4

Mammogram study of a left breast in (A) MLO view and (B) CC view, showing a group of heterogeneous microcalcifications in the upper mid-quadrant, reported as BI-RADS 4B. These calcifications were HPE-proven DCIS.

Figure 5

Mammogram study of a right breast in (A) MLO view and (B) CC view, showing branching pleomorphic calcifications in a segmental distribution in the upper outer-to-mid quadrant, reported as a BI-RADS 4C lesion. A stereotactic-guided hook-wire insertion was performed (hook-wire in CC view), and an HPE of the wide local excision showed invasive carcinoma. We noted an architectural distortion in the upper outer quadrant (arrow) from a previous surgery.

Figure 6

High-density mass with spiculated margin in the upper outer quadrant, associated with pleomorphic calcifications (A,B). A USG of this lesion (C) showed a hypoechoic mass with a spiculated margin, posterior acoustic shadowing, and internal vascularity on Doppler. This was reported as a BI-RADS 5 lesion. USG-guided biopsy was performed and was found to be HPE-proven invasive carcinoma. (Rt breast—right breast, 12.00—12 o’clock position, 1 cm FN—1 cm from nipple). The box represent the lesion and colour area represent blood flow.