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Breast
Lesion Imaging Characteristics
Ultrasound Lesion Characteristics
Calcifications (US)
Calcifications (US)
Regina J. Hooley, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Echogenic foci visible on US, typically corresponding to calcifications (Ca⁺⁺) on mammography
            • Macrocalcifications: Coarse echogenic Ca⁺⁺ (usually ≥ 0.5 mm in diameter) attenuate US beam and cause posterior shadowing
            • Microcalcifications in or outside mass: Too small to cause shadowing
              • Echogenic foci are more conspicuous within mass or duct than within echogenic fibroglandular tissue
              • Threshold for US detection of microcalcifications using 12- to 18-MHz linear transducer is ~ 110 μm (> 0.1 mm)
                • Typically may visualize microcalcifications 0.2-0.5 mm
                  • Dependent on depth, speckle, surrounding tissue
            • Distinguish from acoustic speckle, Cooper ligaments, collagen fibers on end, pectoral muscle fascicles

          IMAGING

          • Mammographic Findings

            • Ultrasonographic Findings

              • Imaging Recommendations

                • Image-Guided Biopsy

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      DIAGNOSTIC CHECKLIST

                      • Consider

                        • Image Interpretation Pearls

                          Selected References

                          1. Machado P et al: Ultrasound detection of microcalcifications in surgical breast specimens. Ultrasound Med Biol. 44(6):1286-90, 2018
                          2. Relea A et al: Usefulness of the twinkling artifact on Doppler ultrasound for the detection of breast microcalcifications. Radiologia. 60(5):413-23, 2018
                          3. Choi JJ et al: Detectability and usefulness of automated whole breast ultrasound in patients with suspicious microcalcifications on mammography: comparison with handheld breast ultrasound. J Breast Cancer. 19(4):429-37, 2016
                          4. Keränen AK et al: Ultrasonography as a guiding method in breast micro-calcification vacuum-assisted biopsies. Ultraschall Med. 37(5):497-502, 2016
                          5. Bae S et al: Breast microcalcifications: diagnostic outcomes according to image-guided biopsy method. Korean J Radiol. 16(5):996-1005, 2015
                          6. Yao JJ et al: Sonographic features of ductal carcinoma in situ of the breast with microinvasion: correlation with clinicopathologic findings and biomarkers. J Ultrasound Med. 34(10):1761-8, 2015
                          7. Akaike G et al: Ultrasonography mapping combined with mammography before breast-conserving surgery for primary breast cancer with microcalcifications: a novel approach. Clin Breast Cancer. 14(5):352-7, 2014
                          8. Grigoryev M et al: Detection of microcalcifications in women with dense breasts and hypoechoic focal lesions: comparison of mammography and ultrasound. Ultraschall Med. 35(6):554-60, 2014
                          9. Chang RF et al: Automatic detection of microcalcifications in breast ultrasound. Med Phys. 40(10):102901, 2013
                          10. Berg WA et al: Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology. 262(2):435-49, 2012
                          11. Evans A et al: Invasive breast cancer: relationship between shear-wave elastographic findings and histologic prognostic factors. Radiology. 263(3):673-7, 2012
                          12. Stöblen F et al: High-frequency breast ultrasound for the detection of microcalcifications and associated masses in BI-RADS 4a patients. Anticancer Res. 31(8):2575-81, 2011
                          13. Cho N et al: Real-time US elastography in the differentiation of suspicious microcalcifications on mammography. Eur Radiol. 19(7):1621-8, 2009
                          14. Cho N et al: Ultrasound-guided vacuum-assisted biopsy of microcalcifications detected at screening mammography. Acta Radiol. 50(6):602-9, 2009
                          15. Feldman MK et al: US artifacts. Radiographics. 29(4):1179-89, 2009
                          16. Okazaki H et al: Radiologic-pathological correlation of punctate hyperechoic foci by ultrasound in stereotactic vacuum-assisted breast biopsy samples. Jpn J Radiol. 27(10):438-43, 2009
                          17. Nagashima T et al: Ultrasound demonstration of mammographically detected microcalcifications in patients with ductal carcinoma in situ of the breast. Breast Cancer. 12(3):216-20, 2005
                          18. Yang WT et al: Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol. 182(1):101-10, 2004
                          19. Chen SC et al: Sonographic differentiation of invasive and intraductal carcinomas of the breast. Br J Radiol. 76(909):600-4, 2003
                          20. Soo MS et al: Sonographic detection and sonographically guided biopsy of breast microcalcifications. AJR Am J Roentgenol. 180(4):941-8, 2003
                          21. Cheung YC et al: Sonographic evaluation of mammographically detected microcalcifications without a mass prior to stereotactic core needle biopsy. J Clin Ultrasound. 30(6):323-31, 2002
                          22. Hashimoto BE et al: High detection rate of breast ductal carcinoma in situ calcifications on mammographically directed high-resolution sonography. J Ultrasound Med. 20(5):501-8, 2001
                          23. Moon WK et al: US of mammographically detected clustered microcalcifications. Radiology. 217(3):849-54, 2000
                          24. Teh WL et al: Ultrasound guided core biopsy of suspicious mammographic calcifications using high frequency and power Doppler ultrasound. Clin Radiol. 55(5):390-4, 2000
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Imaging

                              • Top Differential Diagnoses

                                • Diagnostic Checklist

                                  TERMINOLOGY

                                  • Definitions

                                    • Echogenic foci visible on US, typically corresponding to calcifications (Ca⁺⁺) on mammography
                                    • Macrocalcifications: Coarse echogenic Ca⁺⁺ (usually ≥ 0.5 mm in diameter) attenuate US beam and cause posterior shadowing
                                    • Microcalcifications in or outside mass: Too small to cause shadowing
                                      • Echogenic foci are more conspicuous within mass or duct than within echogenic fibroglandular tissue
                                      • Threshold for US detection of microcalcifications using 12- to 18-MHz linear transducer is ~ 110 μm (> 0.1 mm)
                                        • Typically may visualize microcalcifications 0.2-0.5 mm
                                          • Dependent on depth, speckle, surrounding tissue
                                    • Distinguish from acoustic speckle, Cooper ligaments, collagen fibers on end, pectoral muscle fascicles

                                  IMAGING

                                  • Mammographic Findings

                                    • Ultrasonographic Findings

                                      • Imaging Recommendations

                                        • Image-Guided Biopsy

                                          DIFFERENTIAL DIAGNOSIS

                                            PATHOLOGY

                                            • General Features

                                              DIAGNOSTIC CHECKLIST

                                              • Consider

                                                • Image Interpretation Pearls

                                                  Selected References

                                                  1. Machado P et al: Ultrasound detection of microcalcifications in surgical breast specimens. Ultrasound Med Biol. 44(6):1286-90, 2018
                                                  2. Relea A et al: Usefulness of the twinkling artifact on Doppler ultrasound for the detection of breast microcalcifications. Radiologia. 60(5):413-23, 2018
                                                  3. Choi JJ et al: Detectability and usefulness of automated whole breast ultrasound in patients with suspicious microcalcifications on mammography: comparison with handheld breast ultrasound. J Breast Cancer. 19(4):429-37, 2016
                                                  4. Keränen AK et al: Ultrasonography as a guiding method in breast micro-calcification vacuum-assisted biopsies. Ultraschall Med. 37(5):497-502, 2016
                                                  5. Bae S et al: Breast microcalcifications: diagnostic outcomes according to image-guided biopsy method. Korean J Radiol. 16(5):996-1005, 2015
                                                  6. Yao JJ et al: Sonographic features of ductal carcinoma in situ of the breast with microinvasion: correlation with clinicopathologic findings and biomarkers. J Ultrasound Med. 34(10):1761-8, 2015
                                                  7. Akaike G et al: Ultrasonography mapping combined with mammography before breast-conserving surgery for primary breast cancer with microcalcifications: a novel approach. Clin Breast Cancer. 14(5):352-7, 2014
                                                  8. Grigoryev M et al: Detection of microcalcifications in women with dense breasts and hypoechoic focal lesions: comparison of mammography and ultrasound. Ultraschall Med. 35(6):554-60, 2014
                                                  9. Chang RF et al: Automatic detection of microcalcifications in breast ultrasound. Med Phys. 40(10):102901, 2013
                                                  10. Berg WA et al: Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology. 262(2):435-49, 2012
                                                  11. Evans A et al: Invasive breast cancer: relationship between shear-wave elastographic findings and histologic prognostic factors. Radiology. 263(3):673-7, 2012
                                                  12. Stöblen F et al: High-frequency breast ultrasound for the detection of microcalcifications and associated masses in BI-RADS 4a patients. Anticancer Res. 31(8):2575-81, 2011
                                                  13. Cho N et al: Real-time US elastography in the differentiation of suspicious microcalcifications on mammography. Eur Radiol. 19(7):1621-8, 2009
                                                  14. Cho N et al: Ultrasound-guided vacuum-assisted biopsy of microcalcifications detected at screening mammography. Acta Radiol. 50(6):602-9, 2009
                                                  15. Feldman MK et al: US artifacts. Radiographics. 29(4):1179-89, 2009
                                                  16. Okazaki H et al: Radiologic-pathological correlation of punctate hyperechoic foci by ultrasound in stereotactic vacuum-assisted breast biopsy samples. Jpn J Radiol. 27(10):438-43, 2009
                                                  17. Nagashima T et al: Ultrasound demonstration of mammographically detected microcalcifications in patients with ductal carcinoma in situ of the breast. Breast Cancer. 12(3):216-20, 2005
                                                  18. Yang WT et al: Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol. 182(1):101-10, 2004
                                                  19. Chen SC et al: Sonographic differentiation of invasive and intraductal carcinomas of the breast. Br J Radiol. 76(909):600-4, 2003
                                                  20. Soo MS et al: Sonographic detection and sonographically guided biopsy of breast microcalcifications. AJR Am J Roentgenol. 180(4):941-8, 2003
                                                  21. Cheung YC et al: Sonographic evaluation of mammographically detected microcalcifications without a mass prior to stereotactic core needle biopsy. J Clin Ultrasound. 30(6):323-31, 2002
                                                  22. Hashimoto BE et al: High detection rate of breast ductal carcinoma in situ calcifications on mammographically directed high-resolution sonography. J Ultrasound Med. 20(5):501-8, 2001
                                                  23. Moon WK et al: US of mammographically detected clustered microcalcifications. Radiology. 217(3):849-54, 2000
                                                  24. Teh WL et al: Ultrasound guided core biopsy of suspicious mammographic calcifications using high frequency and power Doppler ultrasound. Clin Radiol. 55(5):390-4, 2000