J Korean Soc Radiol.  2011 Dec;65(6):595-601. 10.3348/jksr.2011.65.6.595.

Clinical Significance and Pathologic Outcomes of Coarse Heterogeneous Calcifications Detected on a Mammography

• Lim HJ
• Cho KR
• Seo BK
• Woo OH
• Hwang KW
• Oh YW
• Bae JW
• Park KH

• KMID: 2002928
• DOI: http://doi.org/10.3348/jksr.2011.65.6.595

Abstract

PURPOSE
To investigate the clinical significance and pathologic outcome of coarse heterogeneous calcifications (CHCs) detected on a mammography.
MATERIALS AND METHODS
A retrospective review of our institutional mammographic database revealed 65 women with CHCs. Of these, we included 27 with pathologic verification (n = 27; benign in 13, malignancy in 14). Mammograms were interpreted in terms of CHC distribution (clustered, linear, segmental, regional, or diffuse), the area of CHCs, and associated findings. We also evaluated the presence of mass, ductal change, or change of parenchymal echogenicity on ultrasound images (n = 26). We correlated and statistically analyzed the radiologic features with pathologic findings.
RESULTS
The individual distributional descriptors of CHCs predicted the risk of malignancy as follows: clustered (8/22); linear (1/2); regional (0/1); segmental (5/5). The segmental distribution predicted malignancy (p < 0.05). The CHC area in malignant lesions was larger than that of benign lesions (p < 0.05). Mammography revealed an associated mass in 2 out of 13 benign and 5 out of 14 malignancies. However, an increased risk of malignancy was not shown by the presence of an associated mass and its larger size. Ultrasound findings were not significant for predicting malignancy.
CONCLUSION
CHCs were verified as malignancy in 52% of cases, especially when characterized by segmental distribution and larger CHC areas on mammography.

MeSH Terms

Breast
Breast Neoplasms
Female
Humans
Mammography
Retrospective Studies
Subject Headings

Figure

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  Fig. 1 A 50-year-old woman with pathologically proven fibrocystic change. A. Mammogram shows an approximately 1 cm sized relatively oval-shaped isodense mass with clustered coarse heterogeneous calcifications (arrows) in the upper central portion of the left breast. B. On breast sonography, this lesion is about 1.2 cm in size with an indistinctly margined hypoechoic mass (arrow).

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  Fig. 2 A 41-year-old woman with pathologically proven ductal carcinoma in situ. A. On mammogram, linear and clustered coarse heterogeneous microcalcifications (arrows) are seen in the right mid inner portion. B. On breast ultrasonography, an indistinct oval-shaped hypoechoic mass with associated calcifications (arrows) is seen in the right breast.

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  Fig. 3 A 47-year-old woman with pathologically proven microinvasive ductal carcinoma in situ. A. On magnification mammogram, coarse heterogeneous microcalcifications (arrows) are found to be clustered in right upper inner quadrant. B. On breast sonography, a 1.1 × 0.8 cm-sized hypoechoic mass (arrows) is seen at a corresponding location.

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