Presentation
Screening mammography. History of breast cancer in first-degree relatives.
Patient Data
Scattered areas of fine pleomorphic and fine linear microcalcifications in segmental distribution are seen in the lower central part of the right breast, associated with a few small spiculated background masses that are highly suspicious of malignancy (BI-RADS 5).
In addition, an enlarged lymph node is evident in the right axillary region.
Case Discussion
The patient underwent an ultrasound-guided core needle biopsy and then right mastectomy and axillary lymphadenectomy. The histopathology and IHC evaluation confirmed invasive breast carcinoma of no special type.
Suspicious breast calcifications, in general, tend to be smaller and less regular than typically benign calcifications and include:
coarse heterogeneous: irregular, generally 0.5-1 mm
amorphous: indistinct and/or small ("powdery", "cloud", or "cottony"), such that another specific shape cannot be determined
fine pleomorphic: variable shape ("shards of glass" or "crushed stone"), generally <0.5 mm
fine linear or fine-linear branching: thin (<0.5 mm), linear, branching or irregularly arranged ("casting")
Amorphous calcifications are usually suspicious (BI-RADS 4) unless they are bilateral and diffuse and/or stable for many years. A group of coarse heterogeneous, amorphous, or fine pleomorphic calcifications are moderately suspicious (BI-RADS 4B), whereas fine linear or fine-linear branching calcifications are highly suspicious (BI-RADS 4C).
In addition, if there is a combination of findings that is highly suggestive of malignancy (e.g. fine linear and branching calcifications in segmental distribution, or microcalcifications associated with a spiculated mass), then a BI-RADS 5 assessment may be appropriate.
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