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Breast
Lesion Imaging Characteristics
Calcifications, Not Typically Benign
Punctate Calcifications
Punctate Calcifications
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Punctate: Subset of round calcifications (Ca⁺⁺) < 0.5 mm
            • Group: ≥ 5 Ca⁺⁺ within 1 cm of each other, or more Ca⁺⁺ within 2 cm, but not in linear distribution
            • Round: Term typically used for Ca⁺⁺ ≥ 0.5 mm

          IMAGING

          • General Features

            • Mammographic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Image-Guided Biopsy

                    • Nuclear Medicine Findings

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          CLINICAL ISSUES

                          • Presentation

                            • Natural History & Prognosis

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Falkner NM et al: Added value of second biopsy target in screen-detected widespread suspicious breast calcifications. J Med Imaging Radiat Oncol. 62(3):299-306, 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. 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
                                  4. Sickles EA et al. Breast Imaging Reporting and Data System, BI-RADS: Mammography. 5th ed. Reston: American College of Radiology, 2013
                                  5. Demetri-Lewis A et al: Breast calcifications: the focal group. AJR Am J Roentgenol. 198:W325-43, 2012
                                  6. 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
                                  7. Burnside ES et al: Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology. 242(2):388-95, 2007
                                  8. D'Orsi CJ et al: Breast Imaging Reporting and Data System: BI-RADS: Mammography. 4th ed. Reston: American College of Radiology, 2003
                                  9. Lawenda BD et al: Dose-volume analysis of radiotherapy for T1N0 invasive breast cancer treated by local excision and partial breast irradiation by low-dose-rate interstitial implant. Int J Radiat Oncol Biol Phys. 56(3):671-80, 2003
                                  10. Schnitt SJ et al: Columnar cell lesions of the breast. Adv Anat Pathol. 10(3):113-24, 2003
                                  11. Jackman RJ et al: Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates. Radiology. 218(2):497-502, 2001
                                  12. Berg WA et al: Breast Imaging Reporting and Data System: inter- and intraobserver variability in feature analysis and final assessment. AJR Am J Roentgenol. 174(6):1769-77, 2000
                                  13. 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
                                  14. Selim A et al: Microscopic localization of calcifications in and around breast carcinoma: a cautionary note for needle core biopsies. Ann Surg. 228(1):95-8, 1998
                                  15. Jackman RJ et al: Atypical ductal hyperplasia diagnosed at stereotactic breast biopsy: improved reliability with 14-gauge, directional, vacuum-assisted biopsy. Radiology. 204(2):485-8, 1997
                                  16. Roubidoux MA et al: Women with breast cancer: histologic findings in the contralateral breast. Radiology. 203(3):691-4, 1997
                                  17. Baker JA et al: Breast imaging reporting and data system standardized mammography lexicon: observer variability in lesion description. AJR Am J Roentgenol. 166(4):773-8, 1996
                                  18. D'Orsi CJ et al: Mammographic feature analysis. Semin Roentgenol. 28(3):204-30, 1993
                                  19. Homer MJ et al: The relationship of mammographic microcalcification to histologic malignancy: radiologic-pathologic correlation. AJR Am J Roentgenol. 153(6):1187-9, 1989
                                  20. Berkowitz JE et al: Dermal breast calcifications: localization with template-guided placement of skin marker. Radiology. 163(1):282, 1987
                                  21. Sickles EA: Breast calcifications: mammographic evaluation. Radiology. 160(2):289-93, 1986
                                  22. Colbassani HJ Jr et al: Mammographic and pathologic correlation of microcalcification in disease of the breast. Surg Gynecol Obstet. 155(5):689-96, 1982
                                  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

                                          • Definitions

                                            • Punctate: Subset of round calcifications (Ca⁺⁺) < 0.5 mm
                                            • Group: ≥ 5 Ca⁺⁺ within 1 cm of each other, or more Ca⁺⁺ within 2 cm, but not in linear distribution
                                            • Round: Term typically used for Ca⁺⁺ ≥ 0.5 mm

                                          IMAGING

                                          • General Features

                                            • Mammographic Findings

                                              • Ultrasonographic Findings

                                                • MR Findings

                                                  • Image-Guided Biopsy

                                                    • Nuclear Medicine Findings

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Natural History & Prognosis

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Falkner NM et al: Added value of second biopsy target in screen-detected widespread suspicious breast calcifications. J Med Imaging Radiat Oncol. 62(3):299-306, 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. 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
                                                                  4. Sickles EA et al. Breast Imaging Reporting and Data System, BI-RADS: Mammography. 5th ed. Reston: American College of Radiology, 2013
                                                                  5. Demetri-Lewis A et al: Breast calcifications: the focal group. AJR Am J Roentgenol. 198:W325-43, 2012
                                                                  6. 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
                                                                  7. Burnside ES et al: Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology. 242(2):388-95, 2007
                                                                  8. D'Orsi CJ et al: Breast Imaging Reporting and Data System: BI-RADS: Mammography. 4th ed. Reston: American College of Radiology, 2003
                                                                  9. Lawenda BD et al: Dose-volume analysis of radiotherapy for T1N0 invasive breast cancer treated by local excision and partial breast irradiation by low-dose-rate interstitial implant. Int J Radiat Oncol Biol Phys. 56(3):671-80, 2003
                                                                  10. Schnitt SJ et al: Columnar cell lesions of the breast. Adv Anat Pathol. 10(3):113-24, 2003
                                                                  11. Jackman RJ et al: Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates. Radiology. 218(2):497-502, 2001
                                                                  12. Berg WA et al: Breast Imaging Reporting and Data System: inter- and intraobserver variability in feature analysis and final assessment. AJR Am J Roentgenol. 174(6):1769-77, 2000
                                                                  13. 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
                                                                  14. Selim A et al: Microscopic localization of calcifications in and around breast carcinoma: a cautionary note for needle core biopsies. Ann Surg. 228(1):95-8, 1998
                                                                  15. Jackman RJ et al: Atypical ductal hyperplasia diagnosed at stereotactic breast biopsy: improved reliability with 14-gauge, directional, vacuum-assisted biopsy. Radiology. 204(2):485-8, 1997
                                                                  16. Roubidoux MA et al: Women with breast cancer: histologic findings in the contralateral breast. Radiology. 203(3):691-4, 1997
                                                                  17. Baker JA et al: Breast imaging reporting and data system standardized mammography lexicon: observer variability in lesion description. AJR Am J Roentgenol. 166(4):773-8, 1996
                                                                  18. D'Orsi CJ et al: Mammographic feature analysis. Semin Roentgenol. 28(3):204-30, 1993
                                                                  19. Homer MJ et al: The relationship of mammographic microcalcification to histologic malignancy: radiologic-pathologic correlation. AJR Am J Roentgenol. 153(6):1187-9, 1989
                                                                  20. Berkowitz JE et al: Dermal breast calcifications: localization with template-guided placement of skin marker. Radiology. 163(1):282, 1987
                                                                  21. Sickles EA: Breast calcifications: mammographic evaluation. Radiology. 160(2):289-93, 1986
                                                                  22. Colbassani HJ Jr et al: Mammographic and pathologic correlation of microcalcification in disease of the breast. Surg Gynecol Obstet. 155(5):689-96, 1982
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