J Breast Cancer.  2009 Sep;12(3):142-150. 10.4048/jbc.2009.12.3.142.

Additional Breast Ultrasound Examinations in Clustered Calcifications: for Improving Diagnostic Performance

• Kim HY
• Seo BK
• Kim HY
• Yie A
• Cho KR
• Seol HY
• Cha SH
• Kim BH
• Son GS
• Bae JW

• KMID: 2242004
• DOI: http://doi.org/10.4048/jbc.2009.12.3.142

Abstract

PURPOSE
We wanted to determine whether additional breast ultrasound examinations are needed for patients who have clustered calcifications found by mammography for the detection of breast carcinomas.
METHODS
We performed targeted ultrasound examinations in 125 consecutive patients who had clustered calcifications found by mammography. Forty-eight pathologically proven patients with 61 breast lesions were included in this study (26 invasive carcinomas, 10 ductal carcinomas in situ and 25 benign diseases). Two breast radiologists evaluated the mammography and the ultrasound findings and they graded the probability of malignancy by consensus as follows: definitely benign 1, probably benign 2, probably malignant 3, and definitely malignant 4. The diagnostic performance values, including the sensitivity, specificity, accuracy, positive predictive value and negative predictive value, for mammography and additional ultrasound were compared using McNemar's test and receiver operating characteristic (ROC) analysis. On the ROC analysis, areas under the ROC curves (AUC) and 95% confidence intervals (CI) were obtained.
RESULTS
The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for making the diagnosis of breast carcinoma by mammography were 88.9%, 12.0%, 57.4%, 59.3%, and 42.9% and those for additional ultrasound were 94.4%, 64.0%, 82.0%, 79.1%, and 88.9%, respectively. The differences of specificity and accuracy were statistically significant (p=0.0003). On the ROC analysis, ACU were significantly different between mammography (AUC=0.586, 95% CI=0.453-0.711) and ultrasound (AUC=0.823, 95% CI=0.704-0.909) (p=0.003). Clustered calcifications with associated masses or ductal changes on additional breast ultrasound had high frequency of malignancies, 79% or 73%. In addition, 87% of malignant masses were invasive carcinomas and 45% of malignant ductal changes were ductal carcinomas in situ.
CONCLUSION
Additional breast ultrasound examinations for the lesions with clustered calcifications on mammography can improve the diagnostic performance and significantly contribute to the specificity and accuracy of a diagnosis of breast carcinoma. In addition, the ultrasound features may predict the pathologic findings such as benignity or malignancy and invasive carcinoma or ductal carcinoma in situ.

Keyword

Breast neoplasms; Calcification; Mammography; Ultrasonography

MeSH Terms

Breast
Breast Neoplasms
Carcinoma, Ductal
Carcinoma, Intraductal, Noninfiltrating
Consensus
Humans
Mammography
ROC Curve
Sensitivity and Specificity

Figure

• 

  Figure 1 A 40-yr-old woman with ductal carcinoma in situ in the right breast. (A) A mediolateral oblique view showing clustered punctate calcifications (arrows) in the right breast, which were assessed as grade 2 for malignancy probability. (B) The ultrasound (US) image showing an associated indistinct irregular mass (arrows) with calcifications (arrowheads), which was assessed as grade 3 for malignancy probability. This case was false negative by mammography and true positive by breast US.

• 

  Figure 2 A 30-yr-old woman with invasive ductal carcinoma in the left breast. (A) A craniocaudal spot compression mammographic view shows clustered coarse heterogeneous calcifications (arrows) in left breast, which was assessed as grade 3. (B) A breast ultrasound (US) image demonstrates an associated mass (arrows) with an irregular shaped, spiculated margined hypoechoic pattern, which was assessed as grade 4. This case was true positive by mammography and breast US.

• 

  Figure 3 A 46-yr-old woman with ductal carcinoma in situ in the left breast. (A) Mediolateral oblique view shows clustered fine pleomorphic calcifications (arrows) in the left breast. Malignancy probability was assessed as grade 4 on mammography. (B) A breast ultrasound (US) image shows associated ductal changes (arrows) with calcifications (arrowheads). On ultrasound, the malignancy probability was assessed as grade 3. This lesion was true positive by mammography and breast US.

• 

  Figure 4 A 48-yr-old woman with nonproliferative fibrocystic change in the left breast. (A) A mediolateral oblique view shows clustered fine pleomorphic calcifications (arrows) in the left breast, which were assessed as grade 3 for malignancy probability. (B) A ultrasound (US) image demonstrates no abnormal finding in the region of interest, and thus the assessment was grade 1 for malignancy probability. This case was false positive by mammography and true negative by breast US.

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  Figure 5 ROC curves for diagnostic performance of mammography and additional US. The AUC was 0.586 (95% CI, 0.453-0.711) for mammography alone and 0.823 (95% CI, 0.704-0.909) for additional breast US evaluation after mammographic examination. This difference was statistically significant (p=0.003). ROC=receiver operating characteristic; US=ultrasound; AUC=areas under the ROC curves; CI=confidence intervals.

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