Microcalcifications Detected as an Abnormality on Screening Mammography: Outcomes and Followup over a Five-Year Period

Abstract

Objectives. This study reviewed the outcome of women attending a breast screening program recalled for assessment of microcalcifications and examined the incidence of a breast carcinoma detected during the following five years in any of the women who were given a benign diagnosis at assessment. Method. A retrospective study consisted of 235 clients attending an Australian BreastScreen program in 2003, who were recalled for investigation of microcalcifications detected on screening mammography. Records for the following five years were available for 168 women in the benign outcome group including those who did not require biopsy at initial assessment. Results. Malignant disease was detected in 26.0% (n = 146) of the women who underwent biopsy. None of the women in the benign outcome group, with available five-year follow-up records, developed a subsequent breast cancer, arising from the calcifications initially recalled in 2003. Conclusions. This study highlights the effectiveness of an Australian screening program in diagnosing malignancy in women with screen detected microcalcification. This has been achieved by correctly determining 38% (n = 235) of the women as benign without the need for biopsy or early recall. A low rate of open surgical biopsies was performed with no cancer diagnoses missed at the time of initial assessment.

Simplifying Breast Imaging Reporting and Data System classification of mammograms with pure suspicious calcifications

“…Similar results to ours have been previously described in everyday clinical practice. 14 – 17 , 25 In an evaluation of needle core biopsy results of patients from the German mammography screening with breast lesions classified as B3, Hoffmann et al. 15 found a PPV of 24% for B3 calcifications and recommended that all B3 lesions should undergo biopsy investigation.…”

“…Craft et al. 14 observed the outcome of 235 women attending a breast screening program who were recalled for assessment of calcifications, and examined the incidence of breast carcinoma detected during the following 5 years. Among B3 calcifications, an incidence of 12.7% of malignancy was observed.…”

“…In the context of public health care, the financial and planning costs might be an obstacle to implement such a short-term follow-up. In the Netherlands, approximately 1 million women join the breast screening program every year, and in Australia and England 1.5 million 27 and 2 million, 28 respectively. Between 1% and 15% of all patients attending breast cancer screening programs worldwide are recalled for further assessment, 29 – 32 and pure calcifications classified as B3 account for approximately 8% of all patient recalls.…”

“…However, it has been difficult for radiologists to properly differentiate between benign and malignant calcifications, especially those classified as B3. 14 – 18 Even the use of additional magnetic resonance imaging tools (e.g. 3T imaging, kinetic analysis, diffusion-weighted imaging) has not resulted in higher sensitivity in classifying suspicious breast calcifications.…”

Precision biopsy of breast microcalcifications: An improvement in surgical excision

“…Breast calcification lesions are notable imaging features of early breast cancer (1). In total, 20-30% of calcification lesions are pathologically confirmed to be of malignant breast cancer (2)(3)(4). Breast microcalcifications lesions are particularly significant for the early diagnosis of breast cancer (5).…”