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Linear Distribution of Calcifications
Wendie A. Berg, MD, PhD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • "Ductal" distribution = subset of "linear" distribution
          • Definitions

            • Calcifications (Ca⁺⁺) arrayed in line, suggesting deposits in duct
            • Most often oriented toward nipple
            • Includes "Y" distribution within duct and minimal branching
            • "Segmental" preferred when Ca⁺⁺ seen in expected course of duct and multiple branches
            • Vascular Ca⁺⁺ in linear distribution in artery wall on both views, usually pathognomonic appearance
            • Distinguish from "curvilinear," which suggests calcification at periphery of round or oval mass, or layering within cysts or microcysts, favoring benign etiology
            • "Fine linear or branching" used to describe individual Ca⁺⁺ morphology, not distribution
            • Linear distribution can also be used to describe multiple masses or nonmass enhancement (NME)

          IMAGING

          • General Features

            • Mammographic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Image-Guided Biopsy

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          CLINICAL ISSUES

                          • Presentation

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Aminololama-Shakeri S et al: Can radiologists predict the presence of ductal carcinoma in situ and invasive breast cancer? AJR Am J Roentgenol. 208(4):933-939, 2017
                                    2. 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
                                    3. Kuhl CK et al: Impact of preoperative breast MR imaging and MR-guided surgery on diagnosis and surgical outcome of women with invasive breast cancer with and without DCIS component. Radiology. 161449, 2017
                                    4. 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
                                    5. Sickles EA et al. ACR BI-RADS Mammography. ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology, 2013
                                    6. Lai KC et al: Linear breast calcifications. AJR Am J Roentgenol. 199(2):W151-7, 2012
                                    7. Narayanan D et al: Interpretation of positron emission mammography: feature analysis and rates of malignancy. AJR Am J Roentgenol. 196(4):956-70, 2011
                                    8. 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
                                    9. Burnside ES et al: Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology. 242(2):388-95, 2007
                                    10. Bazzocchi M et al: Contrast-enhanced breast MRI in patients with suspicious microcalcifications on mammography: results of a multicenter trial. AJR Am J Roentgenol. 186(6):1723-32, 2006
                                    11. Menell JH et al: Determination of the presence and extent of pure ductal carcinoma in situ by mammography and magnetic resonance imaging. Breast J. 11(6):382-90, 2005
                                    12. Morakkabati-Spitz N et al: Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI. Eur Radiol. 15(9):2010-7, 2005
                                    13. Berg WA: Image-guided breast biopsy and management of high-risk lesions. Radiol Clin North Am. 42(5):935-46, vii, 2004
                                    14. Liberman L et al: Ductal enhancement on MR imaging of the breast. AJR Am J Roentgenol. 181(2):519-25, 2003
                                    15. Soo MS et al: Sonographic detection and sonographically guided biopsy of breast microcalcifications. AJR 180:941-8, 2003
                                    16. Liberman L et al: Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol. 179(1):171-8, 2002
                                    17. Nunes LW et al: Update of breast MR imaging architectural interpretation model. Radiology. 219(2):484-94, 2001
                                    18. Bilgen IG et al: Fat necrosis of the breast: clinical, mammographic and sonographic features. Eur J Radiol. 39(2):92-9, 2001
                                    19. Liberman L et al: Bracketing wires for preoperative breast needle localization. AJR Am J Roentgenol. 177(3):565-72, 2001
                                    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. Gluck BS et al: Microcalcifications on postoperative mammograms as an indicator of adequacy of tumor excision. Radiology. 188(2):469-72, 1993
                                    22. Holland R et al: Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ. Lancet. 335(8688):519-22, 1990
                                    Related Anatomy
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Pathology

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Synonyms

                                              • "Ductal" distribution = subset of "linear" distribution
                                            • Definitions

                                              • Calcifications (Ca⁺⁺) arrayed in line, suggesting deposits in duct
                                              • Most often oriented toward nipple
                                              • Includes "Y" distribution within duct and minimal branching
                                              • "Segmental" preferred when Ca⁺⁺ seen in expected course of duct and multiple branches
                                              • Vascular Ca⁺⁺ in linear distribution in artery wall on both views, usually pathognomonic appearance
                                              • Distinguish from "curvilinear," which suggests calcification at periphery of round or oval mass, or layering within cysts or microcysts, favoring benign etiology
                                              • "Fine linear or branching" used to describe individual Ca⁺⁺ morphology, not distribution
                                              • Linear distribution can also be used to describe multiple masses or nonmass enhancement (NME)

                                            IMAGING

                                            • General Features

                                              • Mammographic Findings

                                                • Ultrasonographic Findings

                                                  • MR Findings

                                                    • Nuclear Medicine Findings

                                                      • Image-Guided Biopsy

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Aminololama-Shakeri S et al: Can radiologists predict the presence of ductal carcinoma in situ and invasive breast cancer? AJR Am J Roentgenol. 208(4):933-939, 2017
                                                                      2. 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
                                                                      3. Kuhl CK et al: Impact of preoperative breast MR imaging and MR-guided surgery on diagnosis and surgical outcome of women with invasive breast cancer with and without DCIS component. Radiology. 161449, 2017
                                                                      4. 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
                                                                      5. Sickles EA et al. ACR BI-RADS Mammography. ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology, 2013
                                                                      6. Lai KC et al: Linear breast calcifications. AJR Am J Roentgenol. 199(2):W151-7, 2012
                                                                      7. Narayanan D et al: Interpretation of positron emission mammography: feature analysis and rates of malignancy. AJR Am J Roentgenol. 196(4):956-70, 2011
                                                                      8. 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
                                                                      9. Burnside ES et al: Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology. 242(2):388-95, 2007
                                                                      10. Bazzocchi M et al: Contrast-enhanced breast MRI in patients with suspicious microcalcifications on mammography: results of a multicenter trial. AJR Am J Roentgenol. 186(6):1723-32, 2006
                                                                      11. Menell JH et al: Determination of the presence and extent of pure ductal carcinoma in situ by mammography and magnetic resonance imaging. Breast J. 11(6):382-90, 2005
                                                                      12. Morakkabati-Spitz N et al: Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI. Eur Radiol. 15(9):2010-7, 2005
                                                                      13. Berg WA: Image-guided breast biopsy and management of high-risk lesions. Radiol Clin North Am. 42(5):935-46, vii, 2004
                                                                      14. Liberman L et al: Ductal enhancement on MR imaging of the breast. AJR Am J Roentgenol. 181(2):519-25, 2003
                                                                      15. Soo MS et al: Sonographic detection and sonographically guided biopsy of breast microcalcifications. AJR 180:941-8, 2003
                                                                      16. Liberman L et al: Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol. 179(1):171-8, 2002
                                                                      17. Nunes LW et al: Update of breast MR imaging architectural interpretation model. Radiology. 219(2):484-94, 2001
                                                                      18. Bilgen IG et al: Fat necrosis of the breast: clinical, mammographic and sonographic features. Eur J Radiol. 39(2):92-9, 2001
                                                                      19. Liberman L et al: Bracketing wires for preoperative breast needle localization. AJR Am J Roentgenol. 177(3):565-72, 2001
                                                                      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. Gluck BS et al: Microcalcifications on postoperative mammograms as an indicator of adequacy of tumor excision. Radiology. 188(2):469-72, 1993
                                                                      22. Holland R et al: Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ. Lancet. 335(8688):519-22, 1990