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Fine Linear Calcifications
Wendie A. Berg, MD, PhD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Fine linear branching calcifications (Ca⁺⁺)
              • Branching, casting, dot-dash Ca⁺⁺
            • Definitions

              • Thin, irregular Ca⁺⁺ that appear linear but are discontinuous, measuring < 0.5 mm in diameter
              • Used to define individual Ca⁺⁺ morphology, not distribution per se
              • Distinguish from typically benign, large rod-like (secretory) Ca⁺⁺
              • Distinguish from vascular Ca⁺⁺: Tram-track, superimpose on vessel wall in all views

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Image-Guided Biopsy

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Grimm LJ et al: Suspicious breast calcifications undergoing stereotactic biopsy in women ages 70 and over: Breast cancer incidence by BI-RADS descriptors. Eur Radiol. 27(6):2275-2281, 2017
                                        2. Rauch GM et al: Microcalcifications in 1657 patients with pure ductal carcinoma in situ of the breast: Correlation with clinical, histopathologic, biologic features, and local recurrence. Ann Surg Oncol. 23(2):482-9, 2016
                                        3. Kim SY et al: Evaluation of malignancy risk stratification of microcalcifications detected on mammography: a study based on the 5th edition of BI-RADS. Ann Surg Oncol. 22(9):2895-901, 2015
                                        4. Graf O et al: Large rodlike calcifications at mammography: analysis of morphologic features. AJR Am J Roentgenol. 200(2):299-303, 2013
                                        5. Sickles EA et al. ACR BI-RADS Mammography in ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology, 2013
                                        6. Hayes BD et al: High-grade histologic features of DCIS are associated with R5 rather than R3 calcifications in breast screening mammography. Breast J. 19(3):319-24, 2013
                                        7. Lai KC et al: Linear breast calcifications. AJR Am J Roentgenol. 199(2):W151-7, 2012
                                        8. Brennan ME et al: Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology. 260(1):119-28, 2011
                                        9. Bent CK et al: The positive predictive value of BI-RADS microcalcification descriptors and final assessment categories. AJR Am J Roentgenol. 194(5):1378-83, 2010
                                        10. Månsson E et al: Mammographic casting-type calcifications is not a prognostic factor in unifocal small invasive breast cancer: a population-based retrospective cohort study. J Surg Oncol. 100(8):670-4, 2009
                                        11. Burnside ES et al: Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology. 242(2):388-95, 2007
                                        12. Gombos EC et al: Basal cell carcinoma of the skin presenting as microcalcifications on screening mammography. Breast J. 11(2):149, 2005
                                        13. Saxena A et al: Monckeberg medial calcific sclerosis mimicking malignant calcification pattern at mammography. J Clin Pathol. 58(4):447-8, 2005
                                        14. Haj M et al: Membranous fat necrosis of the breast: diagnosis by minimally invasive technique. Breast J. 10(6):504-8, 2004
                                        15. Gülsün M et al: Evaluation of breast microcalcifications according to Breast Imaging Reporting and Data System criteria and Le Gal's classification. Eur J Radiol. 47(3):227-31, 2003
                                        16. Stomper PC et al: Mammographic predictors of the presence and size of invasive carcinomas associated with malignant microcalcification lesions without a mass. AJR Am J Roentgenol. 181(6):1679-84, 2003
                                        17. Thurfjell MG et al: Nonpalpable breast cancer: mammographic appearance as predictor of histologic type. Radiology. 222(1):165-70, 2002
                                        18. Díaz-Bustamante T et al: Primary amyloidosis of the breast presenting solely as microcalcifications. AJR Am J Roentgenol. 177(4):903-4, 2001
                                        19. Stucker DT et al: New bilateral microcalcifications at mammography in a postlactational woman: case report. Radiology. 217(1):247-50, 2000
                                        20. Liberman L et al: The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories. AJR Am J Roentgenol. 171(1):35-40, 1998
                                        21. Dershaw DD et al: Patterns of mammographically detected calcifications after breast-conserving therapy associated with tumor recurrence. Cancer. 79(7):1355-61, 1997
                                        22. Holland R et al: Microcalcifications associated with ductal carcinoma in situ: mammographic-pathologic correlation. Semin Diagn Pathol. 11(3):181-92, 1994
                                        23. Bassett LW: Mammographic analysis of calcifications. Radiol Clin North Am. 30(1):93-105, 1992
                                        24. Lanyi M: [Pattern analysis of 5641 microcalcifications in 100 mammary duct carcinomas: polymorphism] Rofo. 139(3):240-8, 1983
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Fine linear branching calcifications (Ca⁺⁺)
                                                    • Branching, casting, dot-dash Ca⁺⁺
                                                  • Definitions

                                                    • Thin, irregular Ca⁺⁺ that appear linear but are discontinuous, measuring < 0.5 mm in diameter
                                                    • Used to define individual Ca⁺⁺ morphology, not distribution per se
                                                    • Distinguish from typically benign, large rod-like (secretory) Ca⁺⁺
                                                    • Distinguish from vascular Ca⁺⁺: Tram-track, superimpose on vessel wall in all views

                                                  IMAGING

                                                  • General Features

                                                    • Mammographic Findings

                                                      • Ultrasonographic Findings

                                                        • MR Findings

                                                          • Image-Guided Biopsy

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Grimm LJ et al: Suspicious breast calcifications undergoing stereotactic biopsy in women ages 70 and over: Breast cancer incidence by BI-RADS descriptors. Eur Radiol. 27(6):2275-2281, 2017
                                                                              2. Rauch GM et al: Microcalcifications in 1657 patients with pure ductal carcinoma in situ of the breast: Correlation with clinical, histopathologic, biologic features, and local recurrence. Ann Surg Oncol. 23(2):482-9, 2016
                                                                              3. Kim SY et al: Evaluation of malignancy risk stratification of microcalcifications detected on mammography: a study based on the 5th edition of BI-RADS. Ann Surg Oncol. 22(9):2895-901, 2015
                                                                              4. Graf O et al: Large rodlike calcifications at mammography: analysis of morphologic features. AJR Am J Roentgenol. 200(2):299-303, 2013
                                                                              5. Sickles EA et al. ACR BI-RADS Mammography in ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology, 2013
                                                                              6. Hayes BD et al: High-grade histologic features of DCIS are associated with R5 rather than R3 calcifications in breast screening mammography. Breast J. 19(3):319-24, 2013
                                                                              7. Lai KC et al: Linear breast calcifications. AJR Am J Roentgenol. 199(2):W151-7, 2012
                                                                              8. Brennan ME et al: Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology. 260(1):119-28, 2011
                                                                              9. Bent CK et al: The positive predictive value of BI-RADS microcalcification descriptors and final assessment categories. AJR Am J Roentgenol. 194(5):1378-83, 2010
                                                                              10. Månsson E et al: Mammographic casting-type calcifications is not a prognostic factor in unifocal small invasive breast cancer: a population-based retrospective cohort study. J Surg Oncol. 100(8):670-4, 2009
                                                                              11. Burnside ES et al: Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology. 242(2):388-95, 2007
                                                                              12. Gombos EC et al: Basal cell carcinoma of the skin presenting as microcalcifications on screening mammography. Breast J. 11(2):149, 2005
                                                                              13. Saxena A et al: Monckeberg medial calcific sclerosis mimicking malignant calcification pattern at mammography. J Clin Pathol. 58(4):447-8, 2005
                                                                              14. Haj M et al: Membranous fat necrosis of the breast: diagnosis by minimally invasive technique. Breast J. 10(6):504-8, 2004
                                                                              15. Gülsün M et al: Evaluation of breast microcalcifications according to Breast Imaging Reporting and Data System criteria and Le Gal's classification. Eur J Radiol. 47(3):227-31, 2003
                                                                              16. Stomper PC et al: Mammographic predictors of the presence and size of invasive carcinomas associated with malignant microcalcification lesions without a mass. AJR Am J Roentgenol. 181(6):1679-84, 2003
                                                                              17. Thurfjell MG et al: Nonpalpable breast cancer: mammographic appearance as predictor of histologic type. Radiology. 222(1):165-70, 2002
                                                                              18. Díaz-Bustamante T et al: Primary amyloidosis of the breast presenting solely as microcalcifications. AJR Am J Roentgenol. 177(4):903-4, 2001
                                                                              19. Stucker DT et al: New bilateral microcalcifications at mammography in a postlactational woman: case report. Radiology. 217(1):247-50, 2000
                                                                              20. Liberman L et al: The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories. AJR Am J Roentgenol. 171(1):35-40, 1998
                                                                              21. Dershaw DD et al: Patterns of mammographically detected calcifications after breast-conserving therapy associated with tumor recurrence. Cancer. 79(7):1355-61, 1997
                                                                              22. Holland R et al: Microcalcifications associated with ductal carcinoma in situ: mammographic-pathologic correlation. Semin Diagn Pathol. 11(3):181-92, 1994
                                                                              23. Bassett LW: Mammographic analysis of calcifications. Radiol Clin North Am. 30(1):93-105, 1992
                                                                              24. Lanyi M: [Pattern analysis of 5641 microcalcifications in 100 mammary duct carcinomas: polymorphism] Rofo. 139(3):240-8, 1983