Does establishing a preoperative nomogram including ultrasonographic findings help predict the likelihood of malignancy in patients with microcalcifications?

Hongli Wang,Shiyu Shen,Xiaofang Jiang,Fengyan Yu,Yue Hu,Jianguo Lai,Ran Gu,Fengxi Su,Jingsi Mei,Jiao Li,Fengtao Liu

doi:10.1186/s40644-019-0229-1

Abstract

BackgroundMammography (MG) is highly sensitive for detecting microcalcifications, but has low specificity. This study investigates whether establishing a preoperative nomogram including ultrasonographic findings can help predict the likelihood of malignancy in patients with mammographic microcalcification.MethodsBetween May 2012 and January 2017, 475 patients with suspicious microcalcifications detected on MG underwent ultrasonography (US). The χ2 test was used to screen risk factors among the variables. Then, a multivariate logistic regression analysis was performed to identify independent predictors of malignant microcalcifications. A mammographic nomogram (M nomogram) and mammographic-ultrasonographic nomogram (M-U nomogram) were established based on multivariate logistic regression models. The discriminatory ability and clinical utility of both nomograms were compared by the receiver operating characteristics curve and decision curve analysis. The calibration ability was evaluated using a calibration curve.ResultsAmong the cases, 68.2% (324/475) were pathologically diagnosed as breast cancer and 31.8% (151/475) were benign lesions. Based on multivariate logistic regression analysis, age, clinical manifestation, morphology and distribution of microcalcifications on MG and lesions associated with microcalcifications on US were confirmed as independent predictors of malignant microcalcifications. In terms of discrimination ability, the C-index of the M-U nomogram was significantly higher than that of the M nomogram (0.917 vs 0.897, p = 0.006). The bias-corrected curve was close to the ideal line in the calibration curve. Decision curve analysis suggested that the M-U nomogram was superior to M nomogram.ConclusionsCombining mammographic parameters with ultrasonographic findings in a nomogram provided better performance than an M nomogram alone, especially for dense breasts, which suggests the value of ultrasonographic finding for individualized prediction of malignancy in patients with microcalcifications.

Highlights

Mammography (MG) is highly sensitive for detecting microcalcifications, but has low specificity
The 5th edition of Breast Imaging Reporting and Data System (BI-RADS) suggested subdivisions based on the morphology of suspicious microcalcifications
Unlike morphology, it does not provide recommendations regarding the distribution of suspicious microcalcifications, despite studies showing that the distribution is helpful for predicting malignancy risk [1,2,3,4,5]

Summary

Introduction

Mammography (MG) is highly sensitive for detecting microcalcifications, but has low specificity. This study investigates whether establishing a preoperative nomogram including ultrasonographic findings can help predict the likelihood of malignancy in patients with mammographic microcalcification. The 5th edition of Breast Imaging Reporting and Data System (BI-RADS) suggested subdivisions based on the morphology of suspicious microcalcifications. BI-RADS provides only a range and not exact values of the malignant likelihood of microcalcifications based on morphology. Unlike morphology, it does not provide recommendations regarding the distribution of suspicious microcalcifications, despite studies showing that the distribution is helpful for predicting malignancy risk [1,2,3,4,5]. Combining morphology and distribution descriptors for suspicious microcalcifications has been suggested to provide a more accurate risk stratification [2]

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