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Grouped Distribution of Calcifications
Nicole S. Winkler, MD; Wei Tse Yang, MBBS
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Relatively few calcifications (Ca⁺⁺) occupy small portion of breast (up to 2 cm)
                • At least 5 Ca⁺⁺ grouped within 1 cm of each other (historically "clustered")
                • More numerous Ca⁺⁺ can span up to 2 cm
              • Most common pattern recommended for biopsy

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Image-Guided Biopsy

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. Oligane HC et al: Grouped amorphous calcifications at mammography: Frequently atypical but rarely associated with aggressive malignancy. Radiology. 288(3):671-679, 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. 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
                                          4. Kaltenbach B et al: A matrix of morphology and distribution of calcifications in the breast: Analysis of 849 vacuum-assisted biopsies. Eur J Radiol. 86:221-226, 2017
                                          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. 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
                                          7. Sickles EA et al: Breast Imaging Reporting and Data System: BI-RADS, Mammography. 5th ed. Reston: American College of Radiology, 2013
                                          8. Majewski SA et al: Frequency of carcinoma at secondary imaging-guided percutaneous breast biopsy performed after a high-risk pathologic result at primary biopsy. AJR Am J Roentgenol. 201(2):439-47, 2013
                                          9. Demetri-Lewis A et al: Breast calcifications: the focal group. AJR Am J Roentgenol. 198(4):W325-43, 2012
                                          10. 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
                                          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. Haka AS et al: Identifying microcalcifications in benign and malignant breast lesions by probing differences in their chemical composition using Raman spectroscopy. Cancer Res. 62(18):5375-80, 2002
                                          13. Berg WA et al: Atypical lobular hyperplasia or lobular carcinoma in situ at core-needle breast biopsy. Radiology. 218(2):503-9, 2001
                                          14. Berg WA et al: Biopsy of amorphous breast calcifications: pathologic outcome and yield at stereotactic biopsy. Radiology. 221(2):495-503, 2001
                                          15. Bilgen IG et al: Fat necrosis of the breast: clinical, mammographic and sonographic features. Eur J Radiol. 39(2):92-9, 2001
                                          16. Venta LA et al: Rates and causes of disagreement in interpretation of full-field digital mammography and film-screen mammography in a diagnostic setting. AJR Am J Roentgenol. 176(5):1241-8, 2001
                                          17. Kamal M et al: Fibroadenomatoid hyperplasia: a cause of suspicious microcalcification on mammographic screening. AJR Am J Roentgenol. 171(5):1331-4, 1998
                                          18. 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
                                          19. Dershaw DD et al: Patterns of mammographically detected calcifications after breast-conserving therapy associated with tumor recurrence. Cancer. 79(7):1355-61, 1997
                                          20. Hamby LS et al: Management of mammographic indeterminate lesions. First place winner of the Conrad Jobst Award in the Gold Medal paper competition. Am Surg. 59(1):4-8, 1993
                                          21. Thomas DB et al: Mammographic calcifications and risk of subsequent breast cancer. J Natl Cancer Inst. 85(3):230-5, 1993
                                          22. Winston JS et al: Calcium oxalate is associated with benign breast tissue. Can we avoid biopsy? Am J Clin Pathol. 100(5):488-92, 1993
                                          23. Lanyi M: Diagnosis and Differential Diagnosis of Breast Calcifications. Berlin: Springer-Verlag, 1988
                                          24. Sickles EA: Breast calcifications: mammographic evaluation. Radiology. 160(2):289-93, 1986
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Relatively few calcifications (Ca⁺⁺) occupy small portion of breast (up to 2 cm)
                                                        • At least 5 Ca⁺⁺ grouped within 1 cm of each other (historically "clustered")
                                                        • More numerous Ca⁺⁺ can span up to 2 cm
                                                      • Most common pattern recommended for biopsy

                                                    IMAGING

                                                    • General Features

                                                      • Mammographic Findings

                                                        • Ultrasonographic Findings

                                                          • MR Findings

                                                            • Image-Guided Biopsy

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Oligane HC et al: Grouped amorphous calcifications at mammography: Frequently atypical but rarely associated with aggressive malignancy. Radiology. 288(3):671-679, 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. 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
                                                                                  4. Kaltenbach B et al: A matrix of morphology and distribution of calcifications in the breast: Analysis of 849 vacuum-assisted biopsies. Eur J Radiol. 86:221-226, 2017
                                                                                  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. 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
                                                                                  7. Sickles EA et al: Breast Imaging Reporting and Data System: BI-RADS, Mammography. 5th ed. Reston: American College of Radiology, 2013
                                                                                  8. Majewski SA et al: Frequency of carcinoma at secondary imaging-guided percutaneous breast biopsy performed after a high-risk pathologic result at primary biopsy. AJR Am J Roentgenol. 201(2):439-47, 2013
                                                                                  9. Demetri-Lewis A et al: Breast calcifications: the focal group. AJR Am J Roentgenol. 198(4):W325-43, 2012
                                                                                  10. 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
                                                                                  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. Haka AS et al: Identifying microcalcifications in benign and malignant breast lesions by probing differences in their chemical composition using Raman spectroscopy. Cancer Res. 62(18):5375-80, 2002
                                                                                  13. Berg WA et al: Atypical lobular hyperplasia or lobular carcinoma in situ at core-needle breast biopsy. Radiology. 218(2):503-9, 2001
                                                                                  14. Berg WA et al: Biopsy of amorphous breast calcifications: pathologic outcome and yield at stereotactic biopsy. Radiology. 221(2):495-503, 2001
                                                                                  15. Bilgen IG et al: Fat necrosis of the breast: clinical, mammographic and sonographic features. Eur J Radiol. 39(2):92-9, 2001
                                                                                  16. Venta LA et al: Rates and causes of disagreement in interpretation of full-field digital mammography and film-screen mammography in a diagnostic setting. AJR Am J Roentgenol. 176(5):1241-8, 2001
                                                                                  17. Kamal M et al: Fibroadenomatoid hyperplasia: a cause of suspicious microcalcification on mammographic screening. AJR Am J Roentgenol. 171(5):1331-4, 1998
                                                                                  18. 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
                                                                                  19. Dershaw DD et al: Patterns of mammographically detected calcifications after breast-conserving therapy associated with tumor recurrence. Cancer. 79(7):1355-61, 1997
                                                                                  20. Hamby LS et al: Management of mammographic indeterminate lesions. First place winner of the Conrad Jobst Award in the Gold Medal paper competition. Am Surg. 59(1):4-8, 1993
                                                                                  21. Thomas DB et al: Mammographic calcifications and risk of subsequent breast cancer. J Natl Cancer Inst. 85(3):230-5, 1993
                                                                                  22. Winston JS et al: Calcium oxalate is associated with benign breast tissue. Can we avoid biopsy? Am J Clin Pathol. 100(5):488-92, 1993
                                                                                  23. Lanyi M: Diagnosis and Differential Diagnosis of Breast Calcifications. Berlin: Springer-Verlag, 1988
                                                                                  24. Sickles EA: Breast calcifications: mammographic evaluation. Radiology. 160(2):289-93, 1986