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

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Diagnostic Checklist

          TERMINOLOGY

          • Synonyms

            • Granular calcifications (Ca⁺⁺); shard-like, "crushed stone"
          • Definitions

            • 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

                                        1. Baltzer PAT et al: Is breast MRI a helpful additional diagnostic test in suspicious mammographic microcalcifications? Magn Reson Imaging. 46:70-74, 2018
                                        2. 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
                                        3. 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
                                        4. 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
                                        5. 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
                                        6. 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
                                        7. 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
                                        8. 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
                                        9. Sickles EA et al: Breast Imaging Reporting and Data System, BI-RADS: Mammography. 5th ed. Reston: American College of Radiology, 2013
                                        10. Demetri-Lewis A et al: Breast calcifications: the focal group. AJR Am J Roentgenol. 198(4):W325-43, 2012
                                        11. Salkowski LR et al: Utility of 6-month follow-up imaging after a concordant benign breast biopsy result. Radiology. 2011;258:380-7
                                        12. 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
                                        13. Burnside ES et al: Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology. 242(2):388-95, 2007
                                        14. Bassett LW et al: Diagnosis of Diseases of the Breast. 2nd ed. Philadelphia: WB Saunders, 2005
                                        15. 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
                                        16. 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
                                        17. Liberman L et al: Breast imaging reporting and data system (BI-RADS). Radiol Clin North Am. 40(3):409-30, v, 2002
                                        18. Rosen EL et al: Malignant lesions initially subjected to short-term mammographic follow-up. Radiology. 223(1):221-8, 2002
                                        19. Liberman L et al: Bracketing wires for preoperative breast needle localization. AJR Am J Roentgenol. 177(3):565-72, 2001
                                        20. Lev-Toaff AS et al: Stability of malignant breast microcalcifications. Radiology. 192(1):153-6, 1994
                                        21. Liberman L et al: Stereotaxic 14-gauge breast biopsy: how many core biopsy specimens are needed? Radiology. 192(3):793-5, 1994
                                        22. Stomper PC et al: Ductal carcinoma in situ: the mammographer's perspective. AJR Am J Roentgenol. 162(3):585-91, 1994
                                        23. 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
                                        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

                                                • Synonyms

                                                  • Granular calcifications (Ca⁺⁺); shard-like, "crushed stone"
                                                • Definitions

                                                  • 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

                                                                              1. Baltzer PAT et al: Is breast MRI a helpful additional diagnostic test in suspicious mammographic microcalcifications? Magn Reson Imaging. 46:70-74, 2018
                                                                              2. 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
                                                                              3. 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
                                                                              4. 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
                                                                              5. 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
                                                                              6. 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
                                                                              7. 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
                                                                              8. 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
                                                                              9. Sickles EA et al: Breast Imaging Reporting and Data System, BI-RADS: Mammography. 5th ed. Reston: American College of Radiology, 2013
                                                                              10. Demetri-Lewis A et al: Breast calcifications: the focal group. AJR Am J Roentgenol. 198(4):W325-43, 2012
                                                                              11. Salkowski LR et al: Utility of 6-month follow-up imaging after a concordant benign breast biopsy result. Radiology. 2011;258:380-7
                                                                              12. 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
                                                                              13. Burnside ES et al: Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology. 242(2):388-95, 2007
                                                                              14. Bassett LW et al: Diagnosis of Diseases of the Breast. 2nd ed. Philadelphia: WB Saunders, 2005
                                                                              15. 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
                                                                              16. 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
                                                                              17. Liberman L et al: Breast imaging reporting and data system (BI-RADS). Radiol Clin North Am. 40(3):409-30, v, 2002
                                                                              18. Rosen EL et al: Malignant lesions initially subjected to short-term mammographic follow-up. Radiology. 223(1):221-8, 2002
                                                                              19. Liberman L et al: Bracketing wires for preoperative breast needle localization. AJR Am J Roentgenol. 177(3):565-72, 2001
                                                                              20. Lev-Toaff AS et al: Stability of malignant breast microcalcifications. Radiology. 192(1):153-6, 1994
                                                                              21. Liberman L et al: Stereotaxic 14-gauge breast biopsy: how many core biopsy specimens are needed? Radiology. 192(3):793-5, 1994
                                                                              22. Stomper PC et al: Ductal carcinoma in situ: the mammographer's perspective. AJR Am J Roentgenol. 162(3):585-91, 1994
                                                                              23. 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