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Calcifications with suspicious morphology at mammography: should they all be considered with the same clinical significance?

  • Breast
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Abstract

Objectives

To evaluate the positive predictive values (PPVs) of calcifications with suspicious morphology by incorporating distribution and clinical factors in two separate cohorts to provide more practical guidance for management.

Methods

This retrospective study included 1076 consecutive women from two cohorts (cohort A, 556; cohort B, 520), with calcifications of suspicious morphology seen on mammography that were pathologically confirmed or followed with mammography. Reader-averaged PPVs of the calcifications were analyzed and compared by logistic regression using the generalized estimating equation. Multivariate logistic regression analysis was performed to evaluate independent factors associated with the PPVs of suspicious calcifications.

Results

Overall reader-averaged PPVs of suspicious calcifications were 16.8% and 15.2% in cohort A and B, respectively. Reader-averaged PPVs according to morphology in cohort A and B were as follows: amorphous 9.1%, 6.4%; coarse heterogeneous 16.1%, 22.1%; fine pleomorphic 78.8%, 44.7%; and fine linear branching 78.6%, 85.1%, respectively (p < 0.001). PPVs for diffuse amorphous combinations were 2.6% and 2.6%, and for regional amorphous calcifications, 3.6% and 3.1%, respectively. Among diffuse amorphous calcifications, the PPVs for women ≥ 50 years and women without a personal history of breast cancer ranged from 0.0 to 1.9%.

Conclusions

Amorphous calcifications have lower reader-averaged PPVs compared to calcifications with other suspicious morphology, falling into the BI-RADS 4a assessment (PPV 2–10%). Amorphous calcifications with diffuse distributions detected in women > 50 years old and without a personal history of breast cancer have reader-averaged PPVs < 2.0%. Further prospective studies are necessary to confirm if these patients can be managed with imaging follow-up.

Key Points

• In two cohorts, reader-averaged positive predictive values (PPVs) for suspicious calcifications showed lower rates for amorphous calcifications.

• In two separate cohorts, reader-averaged PPVs showed lower rates for diffuse amorphous calcifications, falling into the BI-RADS 4a assessment category (PPV 2–10%).

• Diffuse amorphous calcifications detected in women > 50 years old and without a personal history of breast cancer have reader-averaged PPVs < 2.0%.

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Abbreviations

ACR BI-RADS:

American College of Radiology Breast Imaging Reporting And Data System

ADH:

Atypical ductal hyperplasia

ALH:

Atypical lobular hyperplasia

CI:

Confidence interval

DCIS:

Ductal carcinoma in situ

FEA:

Flat epithelial atypia

IDP:

Intraductal papilloma

LCIS:

Lobular carcinoma in situ

OR:

Odds ratio

PPV:

Positive predictive value

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Woo Jung Choi & Hee Jung Shin

  2. Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University, College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Kyunghwa Han

  3. Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Jihye Lee & Jung Hyun Yoon

  4. Department of Radiology, Yongin Severance Hospital, Yonsei University, College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Eun-Kyung Kim

Authors
  1. Woo Jung Choi
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  2. Kyunghwa Han
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  3. Hee Jung Shin
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  4. Jihye Lee
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Corresponding author

Correspondence to Jung Hyun Yoon.

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Guarantor

The scientific guarantor of this publication is Jung Hyun Yoon.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Kyunghwa Han, a statistician, kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• multicentre study

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Choi, W.J., Han, K., Shin, H.J. et al. Calcifications with suspicious morphology at mammography: should they all be considered with the same clinical significance?. Eur Radiol 31, 2529–2538 (2021). https://doi.org/10.1007/s00330-020-07215-8

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  • DOI: https://doi.org/10.1007/s00330-020-07215-8

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