Malignant Calcifications Research Articles

Optimal Breast Density Characterization Using a Three-Dimensional Automated Breast Densitometry System.

Dense breasts are a risk factor for breast cancer. Assessment of breast density is important and radiologist-dependent. We objectively measured mammographic density using the three-dimensional automatic mammographic density measurement device Volpara™ and examined the criteria for combined use of ultrasonography (US). Of 1227 patients who underwent primary breast cancer surgery between January 2019 and April 2021 at our hospital, 441 were included. A case series study was conducted based on patient age, diagnostic accuracy, effects of mammography (MMG) combined with US, size of invasion, and calcifications. The mean density of both breasts according to the Volpara Density Grade (VDG) was 0–3.4% in 2 patients, 3.5–7.4% in 55 patients, 7.5–15.4% in 173 patients, and ≥15.5% in 211 patients. Breast density tended to be higher in younger patients. Diagnostic accuracy of MMG tended to decrease with increasing breast density. US detection rates were not associated with VDG on MMG and were favorable at all densities. The risk of a non-detected result was high in patients without malignant suspicious calcifications. Supplementary use of US for patients without suspicious calcifications on MMG and high breast density, particularly ≥25.5%, could improve the breast cancer detection rate.

Time to development and imaging features of new calcifications in the treated breast after breast-conserving therapy.

The purpose of our study was to analyze the time to development, malignancy rate, location, and mammographic features of new calcifications in the treated breast after breast-conserving therapy (BCT). In this HIPAA-complaint, IRB-approved retrospective study, we reviewed the records of patients treated with BCT at our institution with breast-conserving surgery performed between January 1, 2009 and December 31, 2010. A total of 735 breasts in 732 women were included in our study cohort. Factors analyzed included rate of development of new calcifications, malignancy rate of new calcifications, the time between completion of radiation therapy and development of new calcifications, imaging features of new calcifications, and location of the new calcifications in relation to the primary malignancy. During follow-up, new calcifications developed in 155 of the 735 treated breasts (21.1%) and 155 of the 732 women (21.2%). After excluding two cases that were lost to follow-up, the malignancy rate of new calcifications was 5.2% (8/153; 95% CI: 2.3% to 10.0%). The median time to development of the benign calcifications was 27months (range, 2 to 91months) and of the malignant calcifications was 41months (range, 11 to 57months). Of the 20 (13.1%) cases of new calcifications categorized as BI-RADS 3 (probably benign), all were benign on follow-up (19 cases) or on biopsy (1 case). Of the 51 BI-RADS 4 (suspicious) cases, 8 (16%) were biopsy-proven malignant. The malignancy rate was the highest in fine pleomorphic 100% (1/1), followed by amorphous 17%, (5/29), coarse heterogeneous 8% (2/26) and typically benign 0 (0/97) calcifications (p < 0.0001). The malignancy rate was 1.5% (2/137) for new calcifications within the lumpectomy site vs. 37.5% (6/16) for new calcifications outside the lumpectomy site (p < 0.0001) and was 3.4% (5/147) for new calcifications at or within the same quadrant as the lumpectomy site vs. 50.0% (3/6) for new calcifications in a different quadrant from the lumpectomy site (p=0.002). Most new calcifications that developed in the treated breast after BCT were benign. Evaluation of morphology and distribution of those calcifications is imperative. New calcifications in the treated breast outside the lumpectomy site are more likely to be malignant and should be viewed with greater suspicion. Benign calcifications developed earlier than malignant calcifications, but the time courses overlapped.

Breast cancer in young women: Imaging and clinical course.

The purpose of this study was to characterize presenting imaging findings in women younger than 40 diagnosed with invasive breast cancer in the context of pathology and clinical course. Retrospective chart and imaging reviews were performed in patients under 40 diagnosed with breast cancer between July 1, 2004, and December 31, 2013. Patient demographic, imaging, pathology, and clinical data were collected. Overall and recurrence-free survival were estimated using the Kaplan-Meier method. Univariate Cox proportional hazards models were performed to identify factors associated with recurrence-free survival. Our study cohort consisted of 110 patients with invasive mammary carcinoma. One hundred one (91.8%) presented with a palpable mass. The mean size of all lesions on imaging was 3.5cm±2.9cm. Malignant calcifications were present in 54 (49.1%) cases. Imaging demonstrated multifocal or multicentric disease in 45 (40.9%) cases. Seventy four (67.3%) cancers were high grade. Luminal genomic subtypes were the most common (n=61, 55.5%). At presentation, 4 (3.6%) patients had bilateral malignancy and 8 (7.3%) patients had distant metastatic disease. Ninety seven (88.2%) underwent neoadjuvant chemotherapy and 67 (60.9%) underwent radiation therapy. Seventy five (68.2%) of the patients underwent mastectomy. The restricted mean time to recurrence was 9.01years (standard error 3.162months). ER positivity was associated with compromised recurrence-free survival. The overall survival rate was 0.962 at 10years. Young patients diagnosed with breast cancer typically present with advanced breast imaging findings and undergo aggressive treatment. Recurrence often occurs >5years from diagnosis, and ER positive subtypes are at increased risk for recurrence.

Exploring CNN potential in discriminating benign and malignant calcifications in conventional and dual-energy FFDM: simulations and experimental observations.

Purpose: Deep convolutional neural networks (CNN) have demonstrated impressive success in various image classification tasks. We investigated the use of CNNs to distinguish between benign and malignant microcalcifications, using either conventional or dual-energy mammography x-ray images. The two kinds of calcifications, known as type-I (calcium oxalate crystals) and type-II (calcium phosphate aggregations), have different attenuation properties in the mammographic energy range. However, variations in microcalcification shape, size, and density as well as compressed breast thickness and breast tissue background make this a challenging discrimination task for the human visual system. Approach: Simulations (conventional and dual-energy mammography) and phantom experiments (conventional mammography only) were conducted using the range of breast thicknesses and randomly shaped microcalcifications. The off-the-shelf Resnet-18 CNN was trained on the regions of interest with calcification clusters of the two kinds. Results: Both Monte Carlo simulations and experimental phantom data suggest that deep neural networks can be trained to separate the two classes of calcifications with high accuracy, using dual-energy mammograms. Conclusions: Our work shows the encouraging results of using the CNNs for non-invasive testing for type-I and type-II microcalcifications and may stimulate further research in this area with expanding presence of the novel breast imaging modalities like dual-energy mammography or systems using photon-counting detectors.

Automated early breast cancer detection and classification system

Early detection of breast cancer is clinically important to reduce the mortality rate. In this study, a new computer-aided detection (CAD) and classification system is introduced to classify two types of mammogram tumors (i.e., mass and calcification) as either benign or malignant. In this CAD system, the tumor-like regions (TLRs) are identified using the automated optimal Otsu thresholding method. Afterward, deep convolutional neural networks (CNNs) process the extracted TLRs to extract relevant mammogram features, investigating AlexNet and ResNet-50 architectures. The normalized extracted CNN features are further input to a support vector machine classifier to decode the classes of mammogram structures (i.e., Benign Calcification, Benign Mass, Malignant Calcification, and Malignant Mass nodules). The experimental results are tested on 2800 mammogram images from the Curated Breast Imaging Subset of Digital Database of Screening Mammography, a publicly available dataset. The accuracy of the proposed CAD system, to classify the ROI into one of the four classes, achieves 0.91 using AlexNet and 0.84 using ResNet-50 models, using fivefold cross-validation. Comparison results with the related methods confirm the advantages of the proposed CAD system.

Differential Diagnosis of Malignant Thyroid Calcification Nodule Based on Computed Tomography Image Texture

Purpose: Calcification nodules in thyroid can be found in thyroid disease. Current clinical computed tomography systems can be used to detect calcification nodules. Our aim is to identify the nature of thyroid calcification nodule based on plain CT images. Method: Sixty-three patients (36 benign and 27 malignant nodules) found thyroid calcification nodules were retrospectively analyzed, together with computed tomography images and pathology finding. The regions of interest (ROI) of 6464 pixels containing calcification nodules were manually delineated by radiologists in CT plain images. We extracted thirty-one texture features from each ROI. And nineteen texture features were picked up after feature optimization by logistic regression analysis. All the texture features were normalized to [0, 1]. Four classification algorithms, including ensemble learning, support vector machine, K-nearest neighbor, decision tree, were used as classification algorithms to identity the benign and malignant nodule. Accuracy, PPV, NPV, SEN, and AUC were calculated to evaluate the performance of different classifiers. Results: Nineteen texture features were selected after feature optimization by logistic regression analysis (P &lt;0.05). Both Ensemble Learning and Support Vector Machine achieved the highest accuracy of 97.1%. The PPV, NPV, SEN, and SPC are 96.9%, 97.4%, 98.4%, and 95.0%, respectively. The AUC was 1. Conclusion: Texture features extracted from calcification nodules could be used as biomarkers to identify benign or malignant thyroid calcification.

Tattoo pigment mimics malignant breast calcifications in a contralateral axillary lymph node: A rare presentation.

Tattoo pigment mimics malignant breast calcifications in a contralateral axillary lymph node: A rare presentation.

Value of stereotactic 11-gauge vacuum-assisted breast biopsy in non-palpable suspicious calcifications: an eight-year single institution experience with 587 patients.

Vacuum-assisted breast biopsy (VABB) has been routinely recommended for stereotactic intervention in cases of isolate mammographically-detected calcifications. Herein we aimed to evaluate and compare the diagnostic consistency and accuracy of calcified and noncalcified specimens obtained from same sites of sampling on mammography-visible calcifications. In addition, we presented the biopsy procedure and retrospectively evaluated the usefulness of VABB as well as the complications of this technique over an eight-year experience in our centre. This single-institution observational cohort study included 587 patients referred for stereotactic 11-gauge VABB of 594 mammographically-detected calcifications between January 2010 and December 2018. The rate of histopathological underestimation, the false negative, the diagnostic consistency and accuracy between calcified and noncalcified specimens of VABB were comprehensively evaluated based on the surveillance data and final histopathological result of the surgical specimens. In total, 594 biopsy procedures were performed in 587 patients (mean age 46 years, range, 21-80 years). The average number of biopsy specimens was 14.7 (range, 9-21) per lesion. VABB pathological results revealed 471 (79.3%) benign, 39 (6.6%) high-risk, and 84 (14.1%) malignant cases. The diagnostic inconsistency between calcified and noncalcified specimens was 14.6% (105/123) for high-risk and malignant lesions. Furthermore, calcified specimens exhibited higher diagnostic accuracy of malignant lesion as compared with the noncalcified specimens (97.7% versus 82.6%, respectively). Underestimation rate for high-risk lesions and in situ carcinoma was 5.1% and 54.1%, respectively, along with a false negative rate of 6.25%. In addition, mild complications were reported with high patient tolerance. Stereotactic 11G-VABB might be preferred for the investigation of non-palpable mammographically-detected calcifications in terms of accuracy and safety profile. The high prevalence of diagnostic discordance between the specimens with and without calcifications revealed a higher value of calcified specimens in diagnosing high-risk and malignant calcifications.

Can digital breast tomosynthesis improve identification of malignant calcifications?

Digital breast tomosynthesis (DBT) is an emerging imaging tool for both the screening and diagnosis of breast cancers. However, the use of DBT in diagnosis of calcifications remains ambiguous. In this study, we investigated DBT findings that might help differentiate between benign and malignant calcifications. We enrolled 256 subjects and evaluated 303 breasts with grouped or segmental calcifications. All imaging examinations were performed using two-directional full-field digital mammography (FFDM) and DBT. We divided subjects into two groups, namely, "dense" and "fatty," based on the quantity of breast tissue and evaluated whether the growth of cancer causes increased the density overlapping with calcifications. Increased overlapping density was significantly associated with malignant calcifications (p < 0.001), and the identification of increased density was more accurate using DBT than using FFDM. Furthermore, we used DBT to evaluate whether segmental calcifications were continuous or discontinuous. Significantly more malignant than benign calcifications were associated with a continuous distribution (p = 0.035). Increased density overlapping with grouped calcifications was significantly associated with invasive cancers (p = 0.017). The findings of this study suggest that DBT improves the ability to differentiate between benign and malignant calcifications.

Diagnostic Approach to Benign and Malignant Calcifications in the Abdomen and Pelvis.

Intra-abdominal calcifications are common. Multiple pathologic processes manifest within the abdomen and pelvis in association with calcifications, which can be benign, premalignant, or malignant. Although calcium deposition in the abdomen can occur secondary to various mechanisms, the most common cau se is cellular injury that leads to dystrophic calcifications. The authors provide a summary of various common and uncommon calcifications in the abdomen and pelvis, primarily using location to illuminate diagnostic significance. Six broad categories of calcifications in the abdomen and pelvis are recognized: mesenteric, peritoneal, retroperitoneal, organ-based, vascular, and musculoskeletal. In addition to site, the various patterns and morphology of calcifications encountered in various conditions can be helpful for diagnosis, especially those depicted on radiographs. For example, some patterns diagnostic for various conditions include round or oval stones in the biliary or urothelial tracts, curvilinear calcifications associated with cysts or neoplasms, and sheetlike calcifications along peritoneal surfaces in the setting of chronic peritoneal dialysis or metastatic disease. Organ encrustation with calcium may be a premalignant finding (eg, porcelain gallbladder). In addition, the development of calcium after initiation of treatment can be used as an indicator of response in conditions such as tuberculosis, lymphoma, and hydatid disease. As calcifications are almost invariably detected at imaging, it is imperative for radiologists to be aware of their diagnostic implications and use the presence of calcification in an organ, mass, or other anatomic location for problem solving. ©RSNA, 2020.

Primary signet ring cell carcinoma of the breast: A rare entity with unique biological behavior—A clinical study based on pure signet ring cell carcinoma cohort

BackgroundPrimary signet ring cell carcinoma (SRCC) of the breast is a rare entity, and only a few case reports of the pure SRCC cases could be found in English literatures. We summarized the clinicopathological characteristics of a relatively large cohort of pure breast SRCCs for the first time. MethodsWe reviewed the medical records of 23 cases of pure breast SRCC with a median follow-up time of 70 months. ResultsThree patients had bilateral primary breast cancer (BC) and two of them had bilateral pure SRCCs. 30 % of patients had the malignant tumor family history including two bilateral BC patients. Malignant calcification was observed in 35.3 % of mammography images. Multifocal lesions were microscopically found in 26.1 % of cases. 63.6 % of the cases had lymph node metastasis, 45.5 % were classified as Stage III, 69.6 % had high value of Ki-67 index, and 34.8 % were triple negative subtype. 19.0 % of patients had local recurrence, and 52.6 % had distant metastasis. Four in five patients with positive tumor family history and follow-up data had relapse of SRCC. The 5-year overall survival rate was 73.7 %, the 5-year relapse-free survival rate was 54.3 %, and the 5-year breast cancer specific survival rate was 78.3 %. ConclusionPure SRCC of the breast showed an aggressive behavior. Neoadjuvant chemotherapy could be considered, breast-conserving surgery should be prudently chosen, and axillary lymph node dissection may be necessary. The high rate of positive tumor family histories and high bilateral incidence, which showed an adverse effect on prognosis, indicate the unique genetic burden of SRCC.

Abstract P2-01-02: Do decreased breast microcalcifications after neoadjuvant chemotherapy predict pathological complete response?

Abstract Background: Clinical response evaluation by image examination after neoadjuvant chemotherapy for breast cancer is important for determining drug response and progression. Mammography is less correlated with pathological response assessment than magnetic resonance imaging or ultrasonography particularly because mammographic calcifications can increase or decrease in response to neoadjuvant chemotherapy. A conventional theory of breast microcalcifications is that they are likely to paradoxically change with neoadjuvant chemotherapy. Traditionally, microcalcifications have been said to occur due to necrosis. If conventional theory is correct, the increase in necrotic cells would increase microcalcifications in response to neoadjuvant chemotherapy. However, decreased microcalcifications were found as a clinical response to neoadjuvant chemotherapy in many cases. To increase the diagnostic ability of mammography after neoadjuvant chemotherapy, it is important to clarify the cases in which microcalcifications can be reduced by anticancer agents. The present study clarified characteristics of breast cancer cases with decreased microcalcifications after neoadjuvant. Methods: Consecutive patients who received neoadjuvant chemotherapy for breast cancer at our hospital from January 2013 to June 2017 were retrospectively reviewed. Characteristics of cases with microcalcifications before neoadjuvant chemotherapy and those showing a reduction after were examined. Stromal tumor-infiltrating lymphocytes were evaluated in the biopsy. before neoadjuvant chemotherapy based on the protocol of the International TILs Working Group 2014. Pathological complete response was also explored in cases exhibiting a decrease in microcalcifications by neoadjuvant chemotherapy. In addition, sensitivity, specificity, and likelihood ratios were calculated for pCR assessment in patients with segmental microcalcifications, pleomorphic/linear microcalcifications, and microcalcifications without mammographic mass. Results: A total of 184 breast cancer cases, including 8 with synchronous bilateral breast cancer, received neoadjuvant chemotherapy at our hospital. Of them, 114 cases were excluded due to unavailable mammograms at our institute before or after neoadjuvant chemotherapy. Seventy breast cancer cases were included; 37 had no malignant microcalcifications before neoadjuvant chemotherapy and 33 did. Breast cancer with microcalcifications was significantly more positive for human epidermal growth factor receptor 2 than those without microcalcifications (48% versus 22%, P = 0.018). Only 6 out of 33 cases with microcalcifications before neoadjuvant chemotherapy showed a decrease after treatment. These cases tended to have high stromal tumor-infiltrating lymphocytes (50% versus 17%), segmental microcalcifications (66% versus 33%), and pleomorphic/linear microcalcifications (83% versus 37%). The sensitivity of each group, compared with total cases of microcalcifications after neoadjuvant chemotherapy, tended to increase, although no significant difference was observed (sensitivity; patients with segmental microcalcifications, 42.9%; patients with pleomorphic/linear microcalcifications, 57.1%; and patients with microcalcifications but without mass, 50.0%). Conclusion: These results suggest that neoadjuvant chemotherapy is able to decrease malignant calcifications, particularly segmental and pleomorphic/linear microcalcifications and microcalcifications with high stromal tumor-infiltrating lymphocytes. By clarifying the mechanisms of formation and disappearance of microcalcifications, a consensus can be reached on whether microcalcifications apparent by mammography are useful for evaluating response to neoadjuvant chemotherapy. Citation Format: Atsushi Fushimi, Rei Kudo, Hiroshi Takeyama. Do decreased breast microcalcifications after neoadjuvant chemotherapy predict pathological complete response? [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-01-02.

Primary Neuroendocrine Carcinoma of the Breast: Mammographic, Ultrasound, and Magnetic Resonance Imaging Findings

Objective: The purpose of this study was to investigate the mammography, ultrasound (US), magnetic resonance imaging (MRI) features that characterise primary neuroendocrine breast carcinomas (NEBC) to improve the awareness of the disease. Materials and Methods: The mammography, sonography, MRI and pathologic features in a total of 54 pathologically proven NEBC cases at Fudan University Cancer Hospital from January 2003 to January 2013 were retrospectively analysed. All 54 patients were women with a mean age of 65 years old (ranging from 35 to 80 years). Results: The 54 NEBC patients had a total of 63 lesions. Pathological diagnosis included endocrine ductal carcinoma in situ (E-DCIS) in 20 lesions, E-DCIS with microinvasion in 17 and invasive solid neuroendocrine carcinoma in 26 lesions. The imaging characteristics of NEBC is a high-density round mass (64.1%) with obscured or indistinct margins on mammograms. All masses without malignant calcifications are the most frequent appearances. A hypoechoic mass (78.4%) with irregular shape and circumscribed margins on sonograms; and lobular or irregular shaped mass with spiculated margins, associated with homogeneous or heterogeneous enhancement on MR images. The highest positive predictive value (PPV) for BI-RADS (Breast Imaging Reporting and Data System) 4, and 5 categories was seen by MRI (0.67 [4/6]). In total, 5 patients (9.2%) had axillary lymph node metastasis. 52 (82.5%) lesions were estrogen receptor-positive and 52 (82.5%) progesterone receptor-positive. 45 (71.4%) lesions were negative for HER2/neu. Thirty patients bearing NEBC received hormone therapy; 5 of these patients underwent radiotherapy and/or chemotherapy. Compared with pure NEBC, NEBC with invasive showed larger size of the lesion (t = –2.41, P = 0.024). Conclusion: MRI may have a role in early detection of NEBC. No calcification is a notable mammographic feature that differ from invasive mammary carcinoma. Positive estrogen and progesterone receptor results and negative Her2/neu results have been linked more frequently to NEBC especially in elderly woman with a palpable lump or nipple discharge.

Mammography-based radiomic analysis for predicting benign BI-RADS category 4 calcifications

PurposeWe developed and validated a radiomic model based on mammography and assessed its value for predicting the pathological diagnosis of Breast Imaging Reporting and Data System (BI-RADS) category 4 calcifications. Materials and methodsPatients with a total of 212 eligible calcifications were recruited (159 cases in the primary cohort and 53 cases in the validation cohort). In total, 8286 radiomic features were extracted from the craniocaudal (CC) and mediolateral oblique (MLO) images. Machine learning was used to select features and build a radiomic signature. The clinical risk factors were selected from the independent clinical factors through logistic regression analyses. The radiomic nomogram incorporated the radiomic signature and an independent clinical risk factor. The diagnostic performance of the radiomic model and the radiologists’ empirical prediction model was evaluated by the area under the receiver operating characteristic curve (AUC). The differences between the various AUCs were compared with DeLong’s test. ResultsSix radiomic features and the menopausal state were included in the radiomic nomogram, which discriminated benign calcifications from malignant calcifications with an AUC of 0.80 in the validation cohort. The difference between the classification results of the radiomic nomogram and that of radiologists was significant (p < 0.05). Particularly for patients with calcifications that are negative on ultrasounds but can be detected by mammography (MG+/US- calcifications), the identification ability of the radiomic nomogram was very strong. ConclusionsThe mammography-based radiomic nomogram is a potential tool to distinguish benign calcifications from malignant calcifications.

Do Decreased Breast Microcalcifications After Neoadjuvant Chemotherapy Predict Pathologic Complete Response?

BackgroundClinical response evaluation by image examination after neoadjuvant chemotherapy for breast cancer is important for determining drug response and progression. Mammography is less correlated with pathologic response assessment than magnetic resonance imaging or ultrasonography. The present study clarified characteristics of breast cancer patients with decreased microcalcifications after neoadjuvant chemotherapy to increase the accuracy of mammographic assessment. Patients and MethodsConsecutive patients who received neoadjuvant chemotherapy for breast cancer at our hospital from January 2013 to June 2017 were retrospectively reviewed. Characteristics of cases of microcalcifications before neoadjuvant chemotherapy and those showing a reduction after were examined. Stromal tumor-infiltrating lymphocytes were evaluated in the biopsy. Pathologic complete response was also explored in patients exhibiting a decrease in microcalcifications by neoadjuvant chemotherapy. ResultsSeventy breast cancer cases were included; 37 had no malignant microcalcifications before neoadjuvant chemotherapy and 33 did. Breast cancer with microcalcifications was significantly more positive for human epidermal growth factor receptor 2 than those without microcalcifications (48% vs. 22%, P = .018). Only 6 of 33 patients with microcalcifications before neoadjuvant chemotherapy showed a decrease after treatment. These patients tended to have high stromal tumor-infiltrating lymphocytes (50% vs. 17%), segmental microcalcifications (66% vs. 33%), and pleomorphic/linear microcalcifications (83% vs. 37%). ConclusionThese results suggest that neoadjuvant chemotherapy is able to decrease malignant calcifications, particularly segmental and pleomorphic/linear microcalcifications. By clarifying the mechanisms of formation and disappearance of microcalcifications, a consensus can be reached on whether microcalcifications apparent by mammography are useful for evaluating response to neoadjuvant chemotherapy.

Growth Dynamics of Mammographic Calcifications: Differentiating Ductal Carcinoma in Situ from Benign Breast Disease.

Background Most ductal carcinoma in situ (DCIS) lesions are first detected on screening mammograms as calcifications. However, false-positive biopsy rates for calcifications range from 30% to 87%. Improved methods to differentiate benign from malignant calcifications are thus needed. Purpose To quantify the growth rates of DCIS and benign breast disease that manifest as mammographic calcifications. Materials and Methods All calcifications (n = 2359) for which a stereotactic biopsy was performed from 2008 through 2015 at Duke University Medical Center were retrospectively identified. Mammograms from all cases of DCIS (n = 404) were reviewed for calcifications that were visible on mammograms taken at least 6 months before biopsy. Women with at least one prior mammogram with visible calcifications were age- and race-matched 1:2 to women with a benign breast biopsy and calcifications visible on prior mammograms. The long axis of the calcifications was measured on all mammograms. Multivariable adjusted linear mixed-effects models estimated the association of calcification growth rates with patholo findings. Hierarchical clustering accounted for matching benign and DCIS groups. Results A total of 74 DCIS calcifications and 148 benign calcifications were included for final analysis. The median patient age was 62 years (interquartile range, 51-71 years). No significant difference in breast density (P > .05) or number of available mammograms (P > .05) was detected between groups. Calcifications associated with DCIS were larger than those associated with benign breast disease at biopsy (median, 10 mm vs 6 mm, respectively; P < .001). After adjustment, the relative annual increase in the long-axis length of DCIS calcifications was greater than that of benign breast calcifications (96% [95% confidence interval: 72%, 224%] vs 68% [95% confidence interval: 56%, 80%] per year, respectively; P < .001). Conclusion Ductal carcinoma in situ calcifications are more extensive at diagnosis and grow faster in extent than those associated with benign breast disease. The rate of calcification change may help to discriminate benign from malignant calcifications. © RSNA, 2019 Online supplemental material is available for this article.

Does every woman presenting with malignant calcifications require a post lumpectomy mammogram?

Successful breast-conserving surgery (BCS) followed by radiation therapy (XRT) is dependent on complete removal of the cancer with clear surgical margins, providing survival rates equivalent to those observed following mastectomy. In patients who have cancers presenting with microcalcifications, post lumpectomy mammograms (PLM) prior to radiation (XRT) can be performed to ensure that no cancer has been left behind. The purpose of this study was to assess the benefit of PLM in patients with malignant breast tumors presenting with microcalcifications. In this IRB-approved retrospective study, we reviewed medical records for patients with breast cancers presenting with microcalcifications who underwent BCS between February 2008 and June 2013. 198 patients who had a PLM prior to XRT for cancers presenting with microcalcifications were included. Histopathology of the initial lumpectomy revealed invasive carcinoma in 78/198 (39.4%) and DCIS alone in 120/198 (60.6%). 114/198 (58%) patients had negative surgical margins. 7/114 (6%) patients with negative margins had positive PLM and re-excisions that were positive for malignancy: sensitivity 88%, specificity 95%, PPV 58%, NPV 99%. 84/198 patients had positive surgical margins. The diagnostic performance of PLM in this group was: sensitivity 55%, specificity 71%, PPV 66%, NPV 61%. PLM plays an important role in the evaluation of patients undergoing breast conservation for breast cancer presenting with microcalcifications. Residual malignancy was detected on positive PLM in 6% of patients with negative margins.

Conspicuity of suspicious breast lesions on contrast enhanced breast CT compared to digital breast tomosynthesis and mammography.

Compare conspicuity of suspicious breast lesions on contrast-enhanced dedicated breast CT (CEbCT), tomosynthesis (DBT) and digital mammography (DM). 100 females with BI-RADS 4/5 lesions underwent CEbCT and/or DBT prior to biopsy in this IRB approved, HIPAA compliant study. Two breast radiologists adjudicated lesion conspicuity scores (CS) for each modality independently. Data are shown as mean CS ±standard deviation. Two-sided t-test was used to determine significance between two modalities within each subgroup. Multiple comparisons were controlled by the false-discovery rate set to 5%. 50% of studied lesions were biopsy-confirmed malignancies. Malignant masses were more conspicuous on CEbCT than on DBT or DM (9.7 ±0.5, n = 25; 6.8 ± 3.1, n = 15; 6.7 ± 3.0, n = 27; p < 0.05). Malignant calcifications were equally conspicuous on all three modalities (CEbCT 8.7 ± 0.8, n = 18; DBT 8.5 ± 0.6, n = 15; DM 8.8 ± 0.7, n = 23; p = NS). Benign masses were equally conspicuous on CEbCT (6.6 ± 4.1, n = 22); DBT (6.4 ± 3.8, n = 17); DM (5.9 ± 3.6, n = 24; p = NS). Benign calcifications CS were similar between DBT (8.5 ± 1.0, n = 17) and DM (8.8 ± 0.8, n = 26; p = NS) but less conspicuous on CEbCT (4.0 ± 2.9, n = 25, p < 0.001). 55 females were imaged with all modalities. Results paralleled the entire cohort. 69%(n = 62) of females imaged by CEbCT had dense breasts. Benign/malignant lesion CSs in dense/non-dense categories were 4.8 ± 3.7, n = 33, vs 6.0 ± 3.9, n = 14, p = 0.35; 9.2 ± 0.9, n = 29 vs. 9.4 ± 0.7, n = 14; p = 0.29, respectively. Malignant masses are more conspicuous on CEbCT than DM or DBT. Malignant microcalcifications are equally conspicuous on all three modalities. Benign calcifications remain better visualized by DM and DBT than with CEbCT. We observed no differences in benign masses on all modalities. CS of both benign and malignant lesions were independent of breast density. CEbCT is a promising diagnostic imaging modality for suspicious breast lesions.

Analysis of Microcalcifications Using Block Wise Local Binary Pattern and Independent component analysis in Mammograms

In India, the average age of developing a breast cancer has undergone a significant shift over last few decades. Most prominent features that indicate breast cancer are microcalcifications. Microcalcifications are tiny calcium deposits deposited on skin and non-palpable. Automatic analysis of microcalcification helps specialist in having more precise decision. The paper presents an approach that involves classification of microcalcifications into benign/malignant in mammograms. Texture features such LBP and statistical features are extracted from ROIs with microcalcification and independent component analysis is applied to reduce the feature set. These feature set is fed to artificial neural networks to classify the ROIs into malignant and benign calcifications.

Abstract P3-13-10: Factors impacting surgical option in patients who achieved complete response in the breast after neoadjuvant systemic therapy

Abstract Background: Neoadjuvant systemic therapy (NST) is the standard treatment for locally advanced breast cancer. Early studies have demonstrated that the rate of breast conservation was significantly increased and NST is now widely applied to operable breast cancer to increase breast conservation rate and to achieve better cosmetic outcome after breast conservative surgery (BCS). For patients who achieved pathologic complete response (pCR), they were perfect candidate for BCS. However, data from prospectively randomized trials have shown that, with the significantly increase of pCR by adding new drugs in the neoadjuvant regimen, BCS rate does not significantly increased. The purpose of current study is to identify factors that have influence on surgical option in patients that have achieved complete response in the breast after NST. Methods: From January 2009 to July 2016, 1150 patients with breast cancer received NST in our institute. There were 103 patients achieved complete response (CR) in the breast and were included in current analysis. Medical records were reviewed regarding to individual surgeon, pre-NST clinicopathologic characteristics, and post-NST image findings. Risk factors for mastectomy were assessed by univariate and multivariate analyses. Results: Of the 103 patients who achieved CR in the breast, 40 of them (38.8%) received mastectomy. In univariate analysis, physician factor, larger initial tumor size, advanced clinical stages, as well as post-NST image findings including skin change, residual tumor ≥3 cm, short nipple-tumor distance, and residual axillary lymph node(LN) on ultrasound and segmental/diffuse distribution of malignant calcification on mammography were associated with more mastectomy. In multivariate analysis, physician factor (OR=5.192, CI [1.562 – 17.257], p=0.021), residual axillary LN on echography (OR=4.000, CI [1.552 – 10.319], p=0.004), and segmental/diffuse distribution of malignant calcification on mammography (OR=7.500, CI [1.819 – 30.916], p=0.018) were independently related to mastectomy in patients who achieved CR in the breast after NST. Conclusion: Physician factor, residual axillary LN and segmental/diffuse malignant calcifications were risk factors for mastectomy in patients who achieved CR in the breast after NST. In addition to embrace current treatment guidelines of surgical management after NST, our data provide valuable additional information to avoid unnecessary mastectomy. Citation Format: Kou H-W, Shen S-C, Chen S-C. Factors impacting surgical option in patients who achieved complete response in the breast after neoadjuvant systemic therapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-13-10.