Chulalongkorn Medical Journal


Background : The calcifications are commonly observed in mammographicfeature of breast cancer. The assessment of combined descriptorsof calcification may help predict the risk of malignancy.Objective : To study the correlation and assess the accuracy of suspiciouscalcifications in BI-RADS 4 and 5 detected on digital mammographyand pathology.Design : Retrospective reviewMaterial and Methods : Of 176 breasts with suspicious calcifications in BI-RADS 4 and 5were reviewed the descriptors for morphology, distribution andother associated findings by using final category assessment byBI-RADS 5th edition. The definition was compared withhistopathology from core needle biopsy or surgery.Setting : Department of Radiology, King Chulalongkorn Memorial Hospital.Results : Forty-five benign (25.6%) and 131 malignant (74.4%) of 176breast calcifications were confirmed. The positive predictivevalue (PPV) for malignancy according to BI-RADS were asfollows: category 4A, 13/36 (36.1%); category 4B, 22/39 (56.4%);category 4C, 27/30 (90%) and category 5, 69/71(96.2%). PPVs formalignancy significantly increased in morphologic descriptorsincluding amorphous, coarse heterogeneous, fine pleomorphicand fine linear descriptors were 51.7%, 81.2%, 84.6% and 91.4%,respectively. PPVs of distribution descriptors were 70.5% (79/112)of the cluster, 75% (6/8) of the regional, 76.5% (26/34) ofthe segmental and 90.9% (20/22) of the linear distribution.Conclusion : Morphologic descriptors of suspicious calcifications werestatistically significant increasing the risk of malignancy.The most and second most common PPVs of morphologicdescriptors were fine linear and fine pleomorphic descriptors,respectively. The highest PPV of distribution descriptor was lineardistribution.


Faculty of Medicine, Chulalongkorn University

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