Irregular Ca⁺⁺ of varying size and shape; usually < 0.5 mm
Smaller and less defined, more angular and triangular than coarse heterogeneous Ca⁺⁺, not round
Unlike coarse heterogeneous Ca⁺⁺, pleomorphic Ca⁺⁺ are individually discrete and tend not to coalesce
Typically denser and more conspicuous than amorphous Ca⁺⁺
Neither benign nor typically malignant
Fine linear and fine linear branching Ca⁺⁺ more suspicious for malignancy and should be described if present
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Image-Guided Biopsy
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Baltzer PAT et al: Is breast MRI a helpful additional diagnostic test in suspicious mammographic microcalcifications? Magn Reson Imaging. 46:70-74, 2018
Bennani-Baiti B et al: MR imaging for diagnosis of malignancy in mammographic microcalcifications: a systematic review and meta-analysis. Radiology. 283(3):692-701, 2017
Feliciano Y et al: Do calcifications seen on mammography after neoadjuvant chemotherapy for breast cancer always need to be excised? Ann Surg Oncol. 24(6):1492-1498, 2017
Monticciolo DL et al: Six-month short-interval imaging follow-up for benign concordant core needle biopsy of the breast: outcomes in 1444 cases with long-term follow-up. AJR Am J Roentgenol. 1-6, 2016
Raj SD et al: Stereotactic biopsy of segmental breast calcifications: is sampling of anterior and posterior components necessary? Acad Radiol. 23(6):682-6, 2016
Johnson JM et al: Breast cancer detection with short-interval follow-up compared with return to annual screening in patients with benign stereotactic or US-guided breast biopsy results. Radiology. 275(1):54-60, 2015
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
Kikuchi M et al: A new method for differentiating benign and malignant pleomorphic clustered calcifications in mammography. J Nippon Med Sch. 81(2):70-7, 2014
Sickles EA et al: Breast Imaging Reporting and Data System, BI-RADS: Mammography. 5th ed. Reston: American College of Radiology, 2013
Demetri-Lewis A et al: Breast calcifications: the focal group. AJR Am J Roentgenol. 198(4):W325-43, 2012
Salkowski LR et al: Utility of 6-month follow-up imaging after a concordant benign breast biopsy result. Radiology. 2011;258:380-7
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
Burnside ES et al: Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology. 242(2):388-95, 2007
Bassett LW et al: Diagnosis of Diseases of the Breast. 2nd ed. Philadelphia: WB Saunders, 2005
Lomoschitz FM et al: Stereotactic 11-gauge vacuum-assisted breast biopsy: influence of number of specimens on diagnostic accuracy. Radiology. 232(3):897-903, 2004
Margolin FR et al: Stereotactic core breast biopsy of malignant calcifications: diagnostic yield of cores with and cores without calcifications on specimen radiographs. Radiology. 233(1):251-4, 2004
Liberman L et al: Breast imaging reporting and data system (BI-RADS). Radiol Clin North Am. 40(3):409-30, v, 2002
Rosen EL et al: Malignant lesions initially subjected to short-term mammographic follow-up. Radiology. 223(1):221-8, 2002
Liberman L et al: Bracketing wires for preoperative breast needle localization. AJR Am J Roentgenol. 177(3):565-72, 2001
Lev-Toaff AS et al: Stability of malignant breast microcalcifications. Radiology. 192(1):153-6, 1994
Liberman L et al: Stereotaxic 14-gauge breast biopsy: how many core biopsy specimens are needed? Radiology. 192(3):793-5, 1994
Stomper PC et al: Ductal carcinoma in situ: the mammographer's perspective. AJR Am J Roentgenol. 162(3):585-91, 1994
Stomper PC et al: Ductal carcinoma in situ of the breast: correlation between mammographic calcification and tumor subtype. AJR Am J Roentgenol. 159(3):483-5, 1992
Irregular Ca⁺⁺ of varying size and shape; usually < 0.5 mm
Smaller and less defined, more angular and triangular than coarse heterogeneous Ca⁺⁺, not round
Unlike coarse heterogeneous Ca⁺⁺, pleomorphic Ca⁺⁺ are individually discrete and tend not to coalesce
Typically denser and more conspicuous than amorphous Ca⁺⁺
Neither benign nor typically malignant
Fine linear and fine linear branching Ca⁺⁺ more suspicious for malignancy and should be described if present
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Image-Guided Biopsy
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Baltzer PAT et al: Is breast MRI a helpful additional diagnostic test in suspicious mammographic microcalcifications? Magn Reson Imaging. 46:70-74, 2018
Bennani-Baiti B et al: MR imaging for diagnosis of malignancy in mammographic microcalcifications: a systematic review and meta-analysis. Radiology. 283(3):692-701, 2017
Feliciano Y et al: Do calcifications seen on mammography after neoadjuvant chemotherapy for breast cancer always need to be excised? Ann Surg Oncol. 24(6):1492-1498, 2017
Monticciolo DL et al: Six-month short-interval imaging follow-up for benign concordant core needle biopsy of the breast: outcomes in 1444 cases with long-term follow-up. AJR Am J Roentgenol. 1-6, 2016
Raj SD et al: Stereotactic biopsy of segmental breast calcifications: is sampling of anterior and posterior components necessary? Acad Radiol. 23(6):682-6, 2016
Johnson JM et al: Breast cancer detection with short-interval follow-up compared with return to annual screening in patients with benign stereotactic or US-guided breast biopsy results. Radiology. 275(1):54-60, 2015
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
Kikuchi M et al: A new method for differentiating benign and malignant pleomorphic clustered calcifications in mammography. J Nippon Med Sch. 81(2):70-7, 2014
Sickles EA et al: Breast Imaging Reporting and Data System, BI-RADS: Mammography. 5th ed. Reston: American College of Radiology, 2013
Demetri-Lewis A et al: Breast calcifications: the focal group. AJR Am J Roentgenol. 198(4):W325-43, 2012
Salkowski LR et al: Utility of 6-month follow-up imaging after a concordant benign breast biopsy result. Radiology. 2011;258:380-7
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
Burnside ES et al: Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology. 242(2):388-95, 2007
Bassett LW et al: Diagnosis of Diseases of the Breast. 2nd ed. Philadelphia: WB Saunders, 2005
Lomoschitz FM et al: Stereotactic 11-gauge vacuum-assisted breast biopsy: influence of number of specimens on diagnostic accuracy. Radiology. 232(3):897-903, 2004
Margolin FR et al: Stereotactic core breast biopsy of malignant calcifications: diagnostic yield of cores with and cores without calcifications on specimen radiographs. Radiology. 233(1):251-4, 2004
Liberman L et al: Breast imaging reporting and data system (BI-RADS). Radiol Clin North Am. 40(3):409-30, v, 2002
Rosen EL et al: Malignant lesions initially subjected to short-term mammographic follow-up. Radiology. 223(1):221-8, 2002
Liberman L et al: Bracketing wires for preoperative breast needle localization. AJR Am J Roentgenol. 177(3):565-72, 2001
Lev-Toaff AS et al: Stability of malignant breast microcalcifications. Radiology. 192(1):153-6, 1994
Liberman L et al: Stereotaxic 14-gauge breast biopsy: how many core biopsy specimens are needed? Radiology. 192(3):793-5, 1994
Stomper PC et al: Ductal carcinoma in situ: the mammographer's perspective. AJR Am J Roentgenol. 162(3):585-91, 1994
Stomper PC et al: Ductal carcinoma in situ of the breast: correlation between mammographic calcification and tumor subtype. AJR Am J Roentgenol. 159(3):483-5, 1992
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