Mammography: Calcifications
by Phoebe Ann, MD, Fadi Dahoud, and Anne Hoyt, MD
Introduction
Calcifications occur in the breast in varying morphology and distribution; some indicate benignity while others indicate malignancy. The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) 5th edition categorizes calcifications into typically benign and suspicious morphology, as described below.
The typically benign calcifications include the following:
- Skin calcifications
- Vascular calcifications
- Coarse or popcorn-like
- Large rod-like
- “Rim” calcifications
- “Round” calcifications, which include the previously described “round” and “punctate” calcifications
- Dystrophic
- Milk of calcium
- Suture
The calcifications with suspicious morphology include the following:
- Amorphous
- Coarse heterogeneous
- Fine pleomorphic
- Fine linear or fine linear branching
Distribution of calcifications include the following:
- Diffuse
- Segmental
- Regional
- Grouped
- Linear
Typically Benign Calcifications
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Calcifications with Suspicious Morphology
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Distribution
- Distribution of calcifications include the following:
- Diffuse: random distribution throughout the breast, considered benign
- Regional: calcifications cover an extensive area, more than one quadrant
- Grouped/clustered: at least 5 calcifications within 1 cm, often requiring further evaluation.
- Linear: calcifications arranged in a linear path that can branch, suggesting calcified debris within a duct. These require further evaluation.
- Segmental: calcifications follow the anatomic triangular shape of a breast lobe with tip towards the nipple. These require further evaluation.
References
- Nalawade YV. Evaluation of breast calcifications. Indian J Radiol Imaging. 2009 Oct-Dec;19(4):282-6. DOI: 10.4103/0971-3026.57208.
- Rao AA, Feneis J, Lalonde C, Ojeda-Fournier H. A Pictorial Review of Changes in the BI-RADS Fifth Edition. Radiographics. 2016 May-Jun;36(3):623-39. DOI: 10.1148/rg.2016150178.
- Hernandez PLA, Estrada TT, Pizarro AL, Cisternas MLD, Tapia CS. Breast calcifications: description and classification according to BI-RADS 5th Edition. Revista Chilena de Radiologia 2016; 22(2): 80-91.
- Muttarak M, Kongmebhol P, Sukhamwang N. Breast calcifications: which are malignant? Singapore Med J. 2009 Sep;50(9):907-13; quiz 914. PMID: 19787181