Suspicious Microcalcifications Research Articles

Abstract PO3-07-06: Correlation between residual microcalcification and in-breast pathologic response in relation to MRI response and the subtypes after neoadjuvant chemotherapy

Abstract Background The significance of residual microcalcifications after neoadjuvant chemotherapy (NAC) in determining the extent of surgical intervention in breast cancer remains unclear. This study aimed to assess whether residual microcalcifications after NAC correlate with the residual disease in patients with breast cancer stratified by subtypes, particularly in excellent radiologic responders. Methods We conducted a retrospective study of patients with breast cancer who underwent NAC followed by curative surgery between January 2007 and December 2022. We evaluated the presence of suspicious microcalcifications on pre-NAC mammography and residual microcalcifications on post-NAC mammography. In the patients who had residual microcalcifications on post-NAC mammography, the rates of breast pathologic complete response (pCR), defined as the absence of invasive cancer (ypT0/is) or complete breast pCR defined as the absence of invasive cancer and in-situ cancer in the breast (ypT0), was assessed according to the MRI response and subtypes. We defined complete MRI response as the resolution of suspicious enhancement in the breast and axilla after NAC. Results Of the 1078 patients, 554 (51.4%) had suspicious microcalcifications at baseline, of which 518 (93.5%) had residual microcalcifications after NAC. Among the 518 patients with residual microcalcifications, 93 (18.0%) achieved a complete MRI response. We observed a difference in breast pCR rates depending on MRI response and hormone-receptor (HR) status. In the patients without complete MRI response, about one-third of patients (139 of 425 [32.7%]) achieved a breast pCR, irrespective of HR status (19.3% [47 of 244] in HR-positive breast cancer and 50.8% [92 of 181] in HR- negative breast cancer). Of the 93 patients who achieved a complete MRI response, the breast pCR rates were 64.3% (27 of 42) in HR-positive breast cancer and 96.1% (49 of 51) in HR-negative breast cancer, respectively. Moreover, the breast complete pCR rate was 54.8% (23 of 51) in HR-positive breast cancer and 88.2% (45 of 51) in HR-negative breast cancer, including 87.2% (34 of 39) in HR-HER2+ breast cancer and 91.7% (11 of 12) in triple-negative breast cancer. Conclusion Our results suggest that the clinical relevance of the residual microcalcifications differs according to the breast cancer subtypes. For patients with HR-positive breast cancer, removal of the residual microcalcifications should be considered to ensure complete cancer removal, regardless of MRI response. In contrast, de-escalating surgery may be considered in patients with HR-negative breast cancer who achieve complete MRI response after NAC. Citation Format: Soong June Bae, Seung Ho Baek, Seung Eun Lee, Min Ji Kim, Sohyun Moon, Junghyun Kim, Yoonwon Kook, Joon Jeong, Sung Gwe Ahn. Correlation between residual microcalcification and in-breast pathologic response in relation to MRI response and the subtypes after neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-07-06.

Invasive Ductal Carcinoma in Breast Hamartoma: Case Report and Review if the Literature

Hamartoma of the breast is a rare benign lesion composed of a variable quantity of adipose, fibrous and glandular tissue. and rarely transform into malignant lesions. This tumor affects women at any age from puberty. The reported incidence of this anomaly in the literature varies between 0.1 and 0.7% of all benign breast tumors. The radiological and histological aspects are variable and depend on its adipose tissue content. The identification of these lesions makes it possible, on the one hand, to avoid systematic surgical excisions and, on the other hand, will prevent the appearance of breast cancer in these normally benign lesions. In this report, we review the literature and describe a case report of non-specific invasive ductal type infiltrating carcinoma within a Hamartoma in a 48-year-old woman. Mammography, ultrasound and magnetic resonance imaging showed the radiological semiology of a typical Hamartoma with suspicious microcalcifications on mammography. This case illustrates the importance of identifying unusual findings in a typical breast hamartoma during radiological examinations.

A Mammography-Based Radiomic Nomogram for Predicting Malignancy in Breast Suspicious Microcalcifications

Preoperative accurate identification of benign and malignant breast lesions is vital for patients to achieve individualized treatment. This study aimed to develop and validate a mammography-based radiomic nomogram for predicting malignant risk of breast suspicious microcalcifications (MCs). 496 patients with histologically confirmed breast suspicious MCs were randomly divided into the training set (n=346) and validation set (n=150). Radiomics features was extracted from the craniocaudal and mediolateral obliqueimages. Least absolute shrinkage and selection operatoralgorithm were used to select radiomics features, then radiomics score (Rad-score) was calculated. Univariate analysis was used to identify malignant MCs-related clinical independent risk factors. Multivariate logistic regression was used to establish a clinical-radiomics model by incorporating Rad-score and clinic factors. A nomogram was developed to visualize the clinical-radiomics model. The receiver operating characteristic curve, calibration curve and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. The Rad-score was consisted of 29 optimal radiomics features. We developed a nomogram by incorporating Rad-score, menopause status, MCs morphology and distribution, the area under the curvevalueof the combined model was 0.926(95% confidence interval [CI]:0.878-0.975) for the validation set. The calibration curves and DCA indicated the combined model had favorable calibration and clinical utility. The combined model could be considered as a potential imaging marker to predict malignant risk of breast suspicious MCs.

Breast Stereotactic Excision Results

Objective: Suspicious microcalcifications detected in mammographic examinations may appear as early signs of breast malignancies. Microcalcifications that appear only on mammography and are not accompanied by any ultrasonographic mass should be excised after marking with a stereotactic wire, and pathological examination should be performed. In this study, we aimed to analyze the stereotactic biopsy results and share their findings. Methods: Lesions with suspicious microcalcifications on mammography (Figure 1) and in which no mass image was detected in the ultrasonographic response were evaluated retrospectively between January 2016 and December 2022. Excision was applied to the patients after marking with mammography and stereotactic wire. Removal of the suspicious microcalcification area was confirmed by radiography of the specimen in all patients. Pathological examination results of the patients, whether re-excision was made, tumor diameter in cases with malignancy, and follow-up periods of the patients were evaluated. Results: A total of 54 patients who underwent excision due to microcalcification were evaluated in the study. Malignancy was detected in 15 (27.7%) patients. The most common ductal carcinoma in situ (DCIS) was detected. Re-excision was performed in 4 (26.6%) patients, and mastectomy was performed in 2 (13.3%) patients with malignancy. The median tumor diameter of malignant lesions was 9 mm. The mean follow-up period of the patients was found to be 42.46+16.44 months. Conclusion: Suspicious microcalcification areas detected in mammographic examinations, lack of ultrasonographic visibility, and biopsy with another minimally invasive method should be excised after marking with a stereotactic wire. This procedure is an effective method that allows early diagnosis of malignancies.

A cohort study of mammography-guided vacuum-assisted breast biopsy in patients with compressed thin breasts (≦ 3 cm)

ObjectivesIn the women with compressed thin thickness (≦ 3 cm), mammographic guiding vacuum-assist breast biopsy (MG-VABB) is a technical challenge. We herein report their performance of MG-VABB on suspicious microcalcification by modern mammography. MethodsWe retrospectively reviewed the consecutive MG-VABB in our hospital from February 2019 to January 2021. All the patients received biopsy because of suspicious microcalcifications discovered by mammography and had at least one-year post-biopsy follow-up. ResultsWe reviewed 745 consecutive patients revealing 195 with compressed thin breasts ≦ 3 cm (mean age: 50.12 ± 7.0; breast thickness: 24.99 mm range 11.6–30 mm). Of the 191 patients received biopsy, the microcalcification retrieval rate was 97.9%. Using the half-open notch biopsy or horizontal needle approach, the biopsies were technically achieved in 30.4% and 9.4% of patients respectively. Regarding to the gold standard of surgicohistology, the cancer sensitivities was 88.46% and the atypia upgrade rate was 16.67%. There was no statistical difference of the procedure time between stereotactic guided and tomosynthesis guided. ConclusionsThe modern MG-VABB has technically improve the performance of biopsy to the patients with compressed thin breasts (≦ 3 cm), revealing approximate results to those breasts > 3 cm. The diagnosis helps the management of suspicious microcalcifications discovered by mammography.

The Diagnostic Role of Shear Wave Elastography and Superb Microvascular Imaging in the Evaluation of Suspicious Microcalcifications.

The aim of this study was to investigate the role of superb microvascular imaging (SMI) and shear wave elastography (SWE) in the prediction of malignancy and invasiveness of isolated microcalcifications (MC) that can be visualized by ultrasonography (US). Sixty-seven women with MC, who were considered suspicious on mammography were evaluated. Only those lesions that could be visualized by US and presented as non-mass lesion were included. They were evaluated by B-mode US, SMI, and SWE before US-guided core-needle biopsy. B-mode US, SMI (vascular index (SMIvi)), and SWE (E-mean, E-ratio) findings were compared with histopathologic features. Pathology confirmed 45 malignant (21 invasive and 24 in situ carcinomas) and 22 benign lesions. There was a statistically significant difference between malignant and benign groups in terms of size (P = .015), distortion (P = .028), cystic component (P < .001), E-mean (P < .001), E-ratio (P < .001), and SMIvi (P = .006). For differentiation of invasiveness E-mean (P = .002), E-ratio (P = .002), and SMIvi (P = .030) were statistically significant. According to ROC analysis E-mean (cut-off point at 38 kPa) was the most sensitive (78%) and the most specific (95%) value among four numeric parameters (size, SMI, E-mean, and E-ratio) with AUC = 0.895, PPV = 97%, and NPV = 68% in detecting malignancy. In the evaluation of invasiveness, the most sensitive (71.4%) method was SMI (cut-off point at 3.4) and the most specific (72%) method was E-mean (cut-off point at 91.5 kPa). Our study shows that adding SWE and SMI to the sonographic evaluation of MC would be an advantage for US-guided biopsy. Including suspicious areas according to SMI and SWE in the sampling area can help target the invasive part of the lesion and avoid underestimation of core biopsy.

Encapsulated papillary carcinoma of the breast: An institutional case series and literature review.

Encapsulated papillary carcinoma of the breast is rare, making difficult diagnosis and resulting in patients undergoing excision biopsy before definitive surgery. Evidence-based guidelines are sparse. We would like to further elucidate the clinicopathological, treatment and survival outcomes. 54 patients identified, with a median follow up duration of 48 months. Patients' demographics, radiological and clinicopathological characteristics, treatment, adjuvant therapies as well as survival data were analysed. 18 (33.3%) cases were pure EPC, 12 (22.2%) were EPC associated with ductal carcinoma in situ (DCIS) and 24 (44.4%) cases had concurrent invasive ductal carcinoma. EPCs were more likely to present as a solid-cystic mass on sonography (63.8%), regular-shaped (oval or round) (97.9%), lack spiculations (95.7%) and lack suspicious microcalcifications (95.6%). Median tumour size was largest in the EPC with IDC group (18.5 mm). 2 patients developed loco-regional recurrence. Overall survival is good for EPCs of all subtypes. EPC is a rare tumour with excellent prognosis.

Low-Risk Women with Suspicious Microcalcifications in Mammography—Can an Additional Breast MRI Reduce the Biopsy Rate?

In the German Mammography Screening Program, 62% of ductal carcinoma in situ (DCIS) and 38% of invasive breast cancers are associated with microcalcifications (MCs). Vacuum-assisted stereotactic breast biopsies are necessary to distinguish precancerous lesions from benign calcifications because mammographic discrimination is not possible. The aim of this study was to investigate if breast magnetic resonance imaging (MRM) could assist the evaluation of MCs and thus help reduce biopsy rates. In this IRB-approved study, 58 women (mean age 58 +/- 24 years) with 59 suspicious MC clusters in the MG were eligible for this prospective single-center trial. Additional breast magnetic resonance imaging (MRI) was conducted before biopsy. The breast MRI showed a sensitivity of 86%, a specificity of 84%, a positive predictive value (PPV) of 75% and a negative predictive value (NPV) of 91% for the differentiation between benign and malignant in these 59 MCs found with MG. Breast MRI in addition to MG could increase the PPV from 36% to 75% compared to MG alone. The MRI examination led to nine additional suspicious classified lesions in the study cohort. A total of 55% (5/9) of them turned out to be malignant. A total of 32 of 59 (54 %) women with suspicious MCs and benign histology were classified as non-suspicious by MRI. An additionally performed breast MRI could have increased the diagnostic reliability in the assessment of MCs. Further, in our small cohort, a considerable number of malignant lesions without mammographically visible MCs were revealed.

Clustered Microcysts Detected on Breast US in Asymptomatic Women.

To investigate the incidence, outcomes, and imaging characteristics of clustered microcysts detected on breast US in asymptomatic women, and suggest appropriate management guidelines. We identified and reviewed the lesions recorded as "clustered microcysts" on breast US performed in asymptomatic women between August 2014 and December 2019. The final diagnosis was based on pathology and imaging follow-up results for at least 12 months. The incidence was 1.5% and 100 patients with 117 lesions were included. Among 117 lesions, 3 (2.6%), 2 (1.7%), and 112 (95.7%) were malignant, high-risk benign, and benign lesions, respectively. The malignant lesions included two cases of ductal carcinoma in situ and one invasive ductal carcinoma. Two of them were assessed as category 4, showing mammographic suspicious microcalcifications and internal vascularity on Doppler US. The remainder was a false negative case and showed echo pattern change on the 12-month follow-up US. The incidence of clustered microcysts on breast US in asymptomatic women was 1.5% and malignancy rate was 2.6% (3 of 117). Knowledge of outcomes and imaging features of benign and malignant clustered microcysts may be helpful for radiologists, thereby aiding categorization and management recommendations.

Detection of microcalcifications in photon-counting dedicated breast-CT using a deep convolutional neural network: Proof of principle

ObjectiveIn this study, we investigate the feasibility of a deep Convolutional Neural Network (dCNN), trained with mammographic images, to detect and classify microcalcifications (MC) in breast-CT (BCT) images. MethodsThis retrospective single-center study was approved by the local ethics committee. 3518 icons generated from 319 mammograms were classified into three classes: “no MC” (1121), “probably benign MC” (1332), and “suspicious MC” (1065). A dCNN was trained (70% of data), validated (20%), and tested on a “real-world” dataset (10%). The diagnostic performance of the dCNN was tested on a subset of 60 icons, generated from 30 mammograms and 30 breast-CT images, and compared to human reading. ROC analysis was used to calculate diagnostic performance. Moreover, colored probability maps for representative BCT images were calculated using a sliding-window approach. ResultsThe dCNN reached an accuracy of 98.8% on the “real-world” dataset. The accuracy on the subset of 60 icons was 100% for mammographic images, 60% for “no MC”, 80% for “probably benign MC” and 100% for “suspicious MC”. Intra-class correlation between the dCNN and the readers was almost perfect (0.85). Kappa values between the two readers (0.93) and the dCNN were almost perfect (reader 1: 0.85 and reader 2: 0.82). The sliding-window approach successfully detected suspicious MC with high image quality. The diagnostic performance of the dCNN to classify benign and suspicious MC was excellent with an AUC of 93.8% (95% CI 87, 4%–100%). ConclusionDeep convolutional networks can be used to detect and classify benign and suspicious MC in breast-CT images.

Breast Amyloidosis: A Case Report and Literature Review.

Amyloidosis is an uncommon disorder characterized by extracellular accumulation of misfolded proteins in tissues. We report a unique case of localized breast amyloidosis in an asymptomatic 56-year-old woman with systemic lupus erythematosus, presented as suspicious microcalcifications without mass on mammography. Vacuum biopsy confirmed amyloidosis, producing the typical apple-green birefringence under polarized light after staining with Congo-red. Further workup and follow-up to exclude development into systemic amyloidosis or hematologic malignancy is recommended. If negative, the prognosis is very good, thus no further treatment is needed. A brief review of the literature revealed more about the typical findings and recommended management.

EP42.17: Vacuum‐assisted stereotactic breast biopsy and its role in the management of suspicious microcalcifications

EP42.17: Vacuum‐assisted stereotactic breast biopsy and its role in the management of suspicious microcalcifications

Performance of ultrasound guidance for vacuum-assisted biopsy of breast microcalcifications without associated mass

• The accuracy of ultrasound (US)-guided biopsies of suspicious microcalcifications without mass is similar, or even better than results published in literature with stereotactic-guided biopsies. • When the microcalcifications are visible on ultrasound, there is no loss of chance in performing the biopsy under ultrasound guidance rather than under stereotactic guidance. • US guidance allows access to difficult areas for stereotactic, increases the comfort of the patient, avoids compression and irradiation.

Recurrence Yield of Stereotactic Biopsy of Suspicious Calcifications After Breast Conservation Therapy.

AimTo analyze the histopathological outcome of stereotactic biopsies of newly developed suspicious calcifications at lumpectomy scar site in patients with breast conservation surgery (BCS) to determine the incidence of malignancy and the association of mammographic appearance of recurrent microcalcification and their distribution. We also determined the association of disease recurrence with the presence of calcifications in original tumor and lumpectomy resection margins with the risk of recurrence.Materials and methodsThis study is a retrospective review of mammograms of patients with breast cancer from 2010 to 2021 who underwent stereotactic biopsy of newly developed suspicious calcifications at scar site appreciated on annual follow-up mammogram after breast conservation surgery (BCS) with no mass on correlative ultrasound. The radiological and pathological features of the patients' primary tumor and new calcifications were obtained from the hospital's electronic patient record system.ResultsA total of 84 patients with breast cancer developed suspicious microcalcifications at the lumpectomy scar site detected on follow-up mammograms after BCS, and 28.6% showed malignant histopathological outcomes. All malignant cases demonstrated pleomorphic morphology. All amorphous (9.5%) and coarse heterogeneous (54.8%) calcifications were benign. The distribution pattern of recurrent malignant calcifications was grouped in 9.5%, regional in 2.4%, linear in 9.5%, and segmental in 7.1%. Calcifications in primary tumors were found in 20.2% of cases. Positive margins were found in 7.1% of these malignant cases. Statistically, there was a strong association between calcification morphology, calcification distribution, presence of calcifications on baseline mammogram, and tumor resection margins. The presence of calcifications in primary tumors and positive resection margins were identified as significant independent risk factors of malignant recurrent calcifications in the logistic regression model and marginal statistical significance in the multivariable logistic regression (MLR) model.ConclusionThe interval development of pleomorphic calcifications after BCS with either linear or segmental pattern, positive resection margins, and associated calcifications in primary tumors was related to the increase in the risk of recurrence. Although amorphous and coarse heterogeneous morphology with grouped distribution showed benign outcomes, stereotactic biopsy is recommended to exclude disease recurrence in this high-risk patient population.

Positive predictive value of Birads IV Lesions on mammogram in detection of breast carcinoma.

To determine the positive predictive value of Breast Imaging Reporting and Data System category IV lesions, and to evaluate interobserver agreement among radiologists in interpreting the subcategories. The cross-sectional study was conducted at the Dow Institute of Radiology, Dow University of Health Sciences, Karachi, from September 2018 to February 2019, and comprised adult females aged 30-60 years diagnosed with Breast Imaging Reporting and Data System IV. Already diagnosed breast carcinoma patients were excluded. The positive predictive value of Breast Imaging Reporting and Data System category IV was calculated using histopathology findings as the gold standard. Data was analysed using SPSS 22. There were 191 patients with a mean age of 49.01±11.79 years. Positive family history of breast cancer was found in 33(17.3%) subjects. Category IV-A was noted in 53(28.0%) subjects, IV-B in 45(23.6%) and IV-C in 93(48.7%). The overall positive predictive value of category IV was 151(79.1%), IV-A 27(50.9%), IV-B 35(77.7%) and IV-C 89(95.6%). Malignant disease was significantly associated with architectural distortion and suspicious microcalcifications (p<0.001). A good agreement was observed in the categorisation of Breast Imaging Reporting and Data System category IV between observers 1 and 2 (kappa 0.85, 95% confidence interval: 0.70-0.99), between observers 1 and 3 (kappa 0.77, 95% confidence interval: 0.61-0.94), and between observers 2 and 3 (kappa 0.63, 95% confidence interval: 0.43-0.83). Breast Imaging Reporting and Data System BI-RADS IV was found to have a high positive predictive value in the diagnosis of breast cancer. Besides the interobserver agreement in terms of identifying BI-RADS IV subcategories was good.

Additional Excision Biopsy in Patients With Atypical Ductal Hyperplasia at Ultrasound-guided Vacuum-assisted Breast Biopsy.

We conducted this single-center, retrospective study to identify predictors of upgrading to malignancy and to discuss the necessity of additional excision biopsy in patients who were diagnosed with atypical ductal hyperplasia (ADH) at ultrasound (US)-guided vacuum-assisted breast biopsy (VABB) based on our 18-year, single-center experience. The current study was conducted in a total of 12,160 patients who were evaluated at our medical institution during an 18-year period between January of 2003 and December of 2020. We included the patients who were diagnosed with ADH at US-guided VABB using the Mammotome® (Devicor Medical Products, Inc., Cincinnati, OH, USA). We therefore included a total of 114 patients (n=114) with ADH in the current study. Of 114 eligible patients, 36 underwent additional excision biopsy and the remaining 78 did not. Of these 36 patients, 15 were found to have an upgrading to malignancy at a rate of upgrading of 41.7%. These include 7 cases (46.6%) of low-grade ductal carcinoma in situ (DCIS), 3 cases (20.0%) of intermediate grade DCIS, 1 case (6.7%) of microinvasive DCIS, 3 cases (20.0%) of multifocal lobular carcinoma in situ, and 1 case (6.7%) of mucinous carcinoma. Finally, only suspicious microcalcification on mammography was a significant predictor of upgrading to malignancy (p=0.023). An additional excision biopsy is recommended to reduce the rate of upgrading to malignancy in patients who were diagnosed with ADH through a US-guided VABB.

Feasibility study using multifocal Doppler twinkling artifacts to detect suspicious microcalcifications in ex vivo specimens of breast cancer on US

Multifocal Doppler twinkling artifact (MDTA) imaging has shown high detection rates of microcalcifications in phantom studies. We aimed to evaluate its performance in detecting suspicious microcalcifications in comparison with mammography by using ex vivo breast cancer specimens. We prospectively included ten women with breast cancer that presented with calcifications on mammography. Both digital specimen mammography and MDTA imaging were performed for ex vivo breast cancer specimens on the day of surgery. Five breast radiologists marked cells that included suspicious microcalcifications (referred to as ‘positive cell’) on specimen mammographic images using a grid of 5-mm cells. Cells that were marked by at least three readers were considered as ‘consensus-positive’. Matched color Doppler twinkling artifact (CDTA) signals were compared between reconstructed US-MDTA projection images and mammographic images. The median detection rate for each case was 74.7% for positive cells and 96.7% for consensus-positive cells. Of the 10 cases, 90% showed a detection rate of ≥ 80%, with 50% of cases showing a 100% detection rate for consensus-positive cells. The proposed MDTA imaging method showed high performance for detecting suspicious microcalcifications in ex vivo breast cancer specimens, and may be a feasible approach for detecting suspicious breast microcalcifications with US.

Improved automated early detection of breast cancer based on high resolution 3D micro-CT microcalcification images

BackgroundThe detection of suspicious microcalcifications on mammography represents one of the earliest signs of a malignant breast tumor. Assessing microcalcifications’ characteristics based on their appearance on 2D breast imaging modalities is in many cases challenging for radiologists. The aims of this study were to: (a) analyse the association of shape and texture properties of breast microcalcifications (extracted by scanning breast tissue with a high resolution 3D scanner) with malignancy, (b) evaluate microcalcifications’ potential to diagnose benign/malignant patients.MethodsBiopsy samples of 94 female patients with suspicious microcalcifications detected during a mammography, were scanned using a micro-CT scanner at a resolution of 9 μm. Several preprocessing techniques were applied on 3504 extracted microcalcifications. A high amount of radiomic features were extracted in an attempt to capture differences among microcalcifications occurring in benign and malignant lesions. Machine learning algorithms were used to diagnose: (a) individual microcalcifications, (b) samples. For the samples, several methodologies to combine individual microcalcification results into sample results were evaluated.ResultsWe could classify individual microcalcifications with 77.32% accuracy, 61.15% sensitivity and 89.76% specificity. At the sample level diagnosis, we achieved an accuracy of 84.04%, sensitivity of 86.27% and specificity of 81.39%.ConclusionsBy studying microcalcifications’ characteristics at a level of details beyond what is currently possible by using conventional breast imaging modalities, our classification results demonstrated a strong association between breast microcalcifications and malignancies. Microcalcification’s texture features extracted in transform domains, have higher discriminating power to classify benign/malignant individual microcalcifications and samples compared to pure shape-features.

Early results of ultrasound-guided, vacuum-assisted breast biopsy for mammographic microcalcifications: combination with wire localization

Purpose: This study examined the usefulness of ultrasound-guided vacuum-assisted breast biopsy for mammographic microcalcification.Methods: case series from June- 2019 to June-2020 at Breast department Cho Ray hospital. The patients with BI-RADS Category 4 Mammographic microcalcification were included. Most microcalcifications were not observed on ultrasound. Sono-guided J-wire localization was first performed for the suspicious microcalcification area, and the location of the J-wire and calcification was determined with mammography in most cases. Sono-guided VABB was performed after removing the J-wire without a stereotactic device. On the other hand, Sono-guided VABB was performed directly without J-wire localization when microcalcification lesions were identified by mass on ultrasonography. In all cases, calcification was confirmed by specimen mammography and the pathology was performed. A follow-up examination was performed to confirm the presence of complications.Results: A total of 20 lesions of 18 patients with BI-RADS Category 4 Mammographic microcalcification were included. Mean age: 49,44 ± 9,49 (35-66). Mean size of lesions 10,83 ± 3,60 mm, (4-15mm). In 20 lesions, 6 lesions (30%) were diagnosed as a malignancy (2 cases of ductal carcinoma in situ, 3 cases of ductal carcinoma invasive, 1 case of atypical ductal hyperplasia). The remaining 14 lesions (70%) were diagnosed as benign (fibroadenoma: 4; fibrocystic exchange 7, fibrocystic desease: 1, typical hyperplasia : 2). There were no significant complications during follow up after VABB.Conclusion: Sono-guided VABB can be used effectively if combined with wire localization for microcalcification lesions.

Clinical Utility of MicroPure US Imaging for Breast Microcalcifications.

PurposeTo evaluate the performance of MicroPure US imaging to detect and characterize microcalcifications.Materials and MethodsA total of 171 lesions with suspicious microcalcifications seen on mammography and B-mode US were included and simultaneously evaluated using MicroPure US imaging. The size of microcalcifications was divided into small (punctate, amorphous, fine pleomorphic, and fine linear) and large (coarse heterogeneous), and the extent was divided into narrow (grouped) and wide (others). MicroPure US imaging visibility was divided into four types based on the number of microcalcifications on the two images: B > M (more on B-mode), B = M (similar), B < M (more on MicroPure), and negative. Triple pairwise comparison was used to evaluate the imaging features according to the MicroPure US imaging visibility.ResultsAmong the 171 lesions examined, 157 lesions (91.8%) were detected by MicroPure US imaging. The proportion of Breast Imaging Reporting and Data System (BI-RADS) category 4A was significantly higher in the MicroPure positive group, and that of category 4B was significantly higher in the MicroPure negative group (p = 0.035). The other imaging features did not differ. Among the positive MicroPure subgroups, all features showed no significant difference.ConclusionMicroPure US imaging demonstrated 91.8% positivity in detecting microcalcifications on B-mode US. MicroPure US imaging visibility correlated with the BI-RADS category of microcalcifications.