Malignancy Risk Stratification of Suspicious Breast Microcalcifications Detected on Mammograms Using Morphological and Distribution Characteristics Based on the Fifth Edition of BI-RADS

Abstract

Background

Breast cancer is a major cause of mortality and morbidity in women. Hence, detecting suspicious microcalcifications on mammograms can be crucial for early diagnosis.

Aims

To determine the malignancy risk of suspicious microcalcifications detected on mammograms in terms of positive predictive value (PPV) based on morphology and distribution characteristics and correlate results with BI-RADS Atlas, fifth edition and world literature.

Materials and Methods

This is a hospital-based observational study conducted at our institute over 15-month duration and included all symptomatic and asymptomatic females who underwent mammogram, detected with suspicious breast microcalcifications, followed by stereotactic or ultrasound-guided breast biopsy and histopathology.

Statistical Analysis

The chi-square test was used to test the association of the outcome. A p < 0.05 was considered to be statistically significant.

Results

Among 77 lesions, 56 were not associated with mass and 21 were associated with mass. Overall PPV for malignancy of suspicious microcalcifications not associated with mass was 37.5%, and PPV of these according to morphology descriptors was: amorphous 9.5%; coarse heterogeneous 45.4%; fine pleomorphic 50%, and fine linear/fine linear branching 100% (p < 0.001). Overall PPV when associated with mass was 71.4%. PPV of suspicious microcalcifications for distribution descriptors was: regional 0%, grouped 38.9%, linear 66.7%, and segmental 63.2%.

Conclusion

Results of our study correlated well with BI-RADS, fifth edition. Subcategorizing morphology and distribution descriptors provides accurate risk stratification, determines the need for image-guided biopsy, and guides further management strategies.

Keywords

microcalcifications - mammography - biopsy - morphology - distribution

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