Overcalling low-risk findings: grouped amorphous calcifications found at screening mammography associated with minimal cancer risk

Iwase, Madoka; Tsunoda, Hiroko; Nakayama, Kanako; Morishita, Emiko; Hayashi, Naoki; Suzuki, Koyu; Yamauchi, Hideko

doi:10.1007/s12282-016-0742-z

Cited by 14 publications

(24 citation statements)

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“…In a recent study, Iwase et al (8) showed only six of 216 (2.8%) grouped amorphous calcifications were malignant and suggested that biopsy of such calcifications would increase the number of false-positive findings. We found a higher malignancy rate for grouped amorphous calcifications (25 of 356 [7.0%]), which is similar to the findings of a recent study by Kim et al (9), who found seven of 92 grouped amorphous calcifications (7.6%) were malignant (9).…”

Section: Discussionmentioning

confidence: 99%

Grouped Amorphous Calcifications at Mammography: Frequently Atypical but Rarely Associated with Aggressive Malignancy

et al. 2018

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Purpose To determine rate of malignancy at stereotactic biopsy of amorphous calcifications with different distributions using current imaging, clinical, and histopathologic criteria. Materials and Methods From January 2009 to September 2013, this retrospective study reviewed a large set of stereotactic biopsies to identify amorphous calcifications and their clinical, imaging, and histopathologic characteristics. Calcification distribution was correlated with malignancy rate after adjusting for known risk factors using logistic regression. Results Of 1903 sequential biopsies, 546 (28.7%) were for amorphous calcifications. After excluding atypical lesions not excised and patients with more than one biopsy in the same year, 497 lesions from 494 women (median age, 52 years; age range, 30-81 years) remained. Fifty-two (10.5%; 95% confidence interval [CI]: 7.9, 13.5) lesions proved malignant, with 17 of 52 (42.7%) being invasive cancers (median, 0.3 cm; range, 0.1-1.3 cm) and all 17 of them being estrogen and progesterone receptor positive and node negative. Malignancy rates in a segmental (six of 21 [28.6%]), linear (eight of 32 [25.0%]), or multiple group same quadrant (nine of 36 [25.0%]) distribution were significantly higher than malignancy rate in a solitary group of amorphous calcifications (25 of 356 [7.0%]) (P = .004, P = .003, and P = .002, respectively). Of 356 grouped amorphous calcifications, 102 (28.7%) yielded atypical results prompting excision, with three of 102 (2.9%) upgraded to ductal carcinoma in situ at excision. In women younger than 50 years without a personal history of cancer, grouped amorphous calcifications showed four of 127 (3.1%) (95% CI: 0.9, 7.9) were malignant and 39 of 127 (30.7%) were atypical at final histopathology. Conclusion Biopsy of amorphous calcifications remains necessary, with an overall malignancy rate of 10.5%; only 17 of 497 (3.4%) biopsies showed invasive cancer, and all of these were estrogen and progesterone receptor positive. Grouped amorphous calcifications in women younger than 50 years without history of breast or ovarian cancer showed a low malignancy rate of 3.1% (four of 127).

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Section: Discussionmentioning

confidence: 99%

Grouped Amorphous Calcifications at Mammography: Frequently Atypical but Rarely Associated with Aggressive Malignancy

et al. 2018

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“…2 Amorphous was one of the suspicious morphologies of calcifications categorized by the 5th edition of the Breast Imaging Reporting and Data System (BI-RADS), defined as relatively small and fuzzy calcifications with diameters less than 0.5 mm and was recommended as category 4B with a positive predictive value (PPV) of approximately 20%. 3 Currently, several studies [4][5][6][7] have suggested that not all amorphous calcifications require a biopsy. Especially for grouped amorphous calcifications found by screening mammograms, biopsy may lead to false positives and overdiagnosis.…”

Section: Introductionmentioning

confidence: 99%

Malignancy Risk Stratification Prediction of Amorphous Calcifications Based on Clinical and Mammographic Features

Shen¹,

Ma²,

Shen³

et al. 2021

CMAR

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To explore the potential factors influencing the malignancy risk of amorphous calcifications and establish a predictive nomogram for malignancy risk stratification. Patients and Methods: Consecutive mammograms from January 2013 to December 2018 were retrospectively reviewed. Traditional clinical features were recorded, and mammographic features were estimated according to the 5th BI-RADS. Included calcifications were randomly divided into the training and validation cohorts. A nomogram was developed to graphically predict the risk of malignancy (risk) based on stepwise multivariate logistic regression analysis. The discrimination and calibration performance of the model were assessed in both the training and validation cohorts. Results: Finally, 1018 amorphous calcifications with final pathological results in 907 women were identified with a malignancy rate of 28.4% (95% CI: 25.7%, 31.3%). The malignancy rates of subgroups divided by the distribution of calcifications, quantity of calcifications, age, menopausal status and family history of cancer were significantly different. There were 712 cases and 306 cases in the training and validation cohorts. The prediction nomogram was finally developed based on four risk factors, including age and distribution, maximum diameter and quantity of calcifications. The AUC of the nomogram was 0.799 (95% CI: 0.761, 0.836) in the training cohort and 0.795 (95% CI: 0.738, 0.852) in the validation cohort. Conclusion: On mammography, the distribution, maximum diameter and quantity of calcifications are independent predictors of malignant amorphous calcifications and can be easily obtained in the clinic. The nomogram developed in this study for individualized malignancy risk stratification of amorphous calcifications shows good discrimination performance.

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“…False-positive results and unnecessary recalls or biopsies are considerable disadvantages of screening. The appropriate application of BI-RADS category 4 and its subdivision, which account for the majority of tissue diagnosis recommendations, is a crucial aspect of addressing these concerns (6,7). Unfortunately, category 4 subdivisions are infrequently utilized (33%) and used even less for calcifications than for architectural distortion or asymmetry (7).…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies revealed the lowest PPV of amorphous calcification to range from 7.2% to 10.5%, even within the range of category 4A (2,3,9). To stratify its likelihood of malignancy and reduce unnecessary biopsies, 'grouped' amorphous calcification was investigated and lowered all PPVs, which ranged from 2.8% to 7.6%, corresponding to category 3 or 4A (2,3,6,9). In our study, however, coarse heterogeneous morphology had a lower PPV (11.1%) than amorphous morphology (13.0%) (Table 1), and 'grouped' coarse heterogeneous calcification had much lower PPV (7%) than 'grouped' amorphous calcification (16%).…”

Section: Discussionmentioning

confidence: 99%

Scoring System to Stratify Malignancy Risks for Mammographic Microcalcifications Based on Breast Imaging Reporting and Data System 5th Edition Descriptors

et al. 2019

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ObjectiveTo develop a scoring system stratifying the malignancy risk of mammographic microcalcifications using the 5th edition of the Breast Imaging Reporting and Data System (BI-RADS).Materials and MethodsOne hundred ninety-four lesions with microcalcifications for which surgical excision was performed were independently reviewed by two radiologists according to the 5th edition of BI-RADS. Each category's positive predictive value (PPV) was calculated and a scoring system was developed using multivariate logistic regression. The scores for benign and malignant lesions or BI-RADS categories were compared using an independent t test or by ANOVA. The area under the receiver operating characteristic curve (AUROC) was assessed to determine the discriminatory ability of the scoring system. Our scoring system was validated using an external dataset.ResultsAfter excision, 69 lesions were malignant (36%). The PPV of BI-RADS descriptors and categories for calcification showed significant differences. Using the developed scoring system, mean scores for benign and malignant lesions or BI-RADS categories were significantly different (p < 0.001). The AUROC of our scoring system was 0.874 (95% confidence interval, 0.840–0.909) and the PPV of each BI-RADS category determined by the scoring system was as follows: category 3 (0%), 4A (6.8%), 4B (19.0%), 4C (68.2%), and 5 (100%). The validation set showed an AUROC of 0.905 and PPVs of 0%, 8.3%, 11.9%, 68.3%, and 94.7% for categories 3, 4A, 4B, 4C, and 5, respectively.ConclusionA scoring system based on BI-RADS morphology and distribution descriptors could be used to stratify the malignancy risk of mammographic microcalcifications.

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Overcalling low-risk findings: grouped amorphous calcifications found at screening mammography associated with minimal cancer risk

Cited by 14 publications

References 10 publications

Grouped Amorphous Calcifications at Mammography: Frequently Atypical but Rarely Associated with Aggressive Malignancy

Grouped Amorphous Calcifications at Mammography: Frequently Atypical but Rarely Associated with Aggressive Malignancy

Malignancy Risk Stratification Prediction of Amorphous Calcifications Based on Clinical and Mammographic Features

Scoring System to Stratify Malignancy Risks for Mammographic Microcalcifications Based on Breast Imaging Reporting and Data System 5th Edition Descriptors

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