J Korean Soc Radiol.  2017 Apr;76(4):251-258. 10.3348/jksr.2017.76.4.251.

Retrospective Analysis on Malignant Calcification Previously Misdiagnosed as Benign on Screening Mammography

• Ha SM
• Cha JH
• Kim HH
• Shin HJ
• Chae EY
• Choi WJ

• KMID: 2373961
• DOI: http://doi.org/10.3348/jksr.2017.76.4.251

Abstract

PURPOSE
The purpose of our study was to investigate the morphology and distribution of calcifications initially interpreted as benign or probably benign, but proven to be malignant by subsequent stereotactic biopsy, and to identify the reason for misinterpretation or underestimation at the initial diagnosis.
MATERIALS AND METHODS
Out of 567 women who underwent stereotactic biopsy for calcifications at our hospital between January 2012 and December 2014, 167 women were diagnosed with malignancy. Forty-six of these 167 women had previous mammography assessed as benign or probably benign which was changed to suspicious malignancy on follow-up mammography. Of these 46 women, three women with biopsy-proven benign calcifications at the site of subsequent cancer were excluded, and 43 patients were finally included. The calcifications (morphology, distribution, extent, associated findings) in the previous and follow-up mammography examinations were analyzed according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon and assessment category. We classified the patients into two groups: 1) group A patients who were still retrospectively re-categorized as less than or equal to BI-RADS 3 and 2) group B patients who were re-categorized as equal to or higher than BI-RADS 4a and whose results should have prompted previous diagnostic assessment.
RESULTS
In the follow-up mammography examinations, change in calcification morphology (n = 27, 63%) was the most frequent cause of assessment change. The most frequent previous mammographic findings of malignant calcification were amorphous morphology (n = 26, 60%) and grouped distribution (n = 36, 84%). The most frequent calcification findings at reassessment were amorphous morphology (n = 4, 9%), fine pleomorphic calcification (n = 30, 70%), grouped distribution (n = 23, 53%), and segmental calcification (n = 12, 28%). There were 33 (77%) patients in group A, and 10 patients (23%) in group B.
CONCLUSION
Amorphous morphology and grouped distribution were the most frequent mammographic findings of calcifications that were misinterpreted or underestimated by the initial radiologist and confirmed as malignancy at follow-up.

MeSH Terms

Biopsy
Breast
Diagnosis
Female
Follow-Up Studies
Humans
Information Systems
Mammography*
Mass Screening*
Retrospective Studies*

Figure

• 

  Fig. 1 Mammographic images of a 59-year-old woman diagnosed with ductal carcinoma in situ. The initial mammographic image (A) is interpreted as showing scattered, punctate, and amorphous calcifications (arrows), which are categorized as BI-RADS category 3 and later re-categorized as BI-RADS category 3, without a magnification view (group A). A follow-up mammographic image with a magnification view (B) shows fine pleomorphic calcifications (arrows), which have increased in their extent, with segmental distribution. The calcifications are thus categorized as BI-RADS category 4a. BI-RADS = Breast Imaging Reporting and Data System

• 

  Fig. 2 Mammographic images of a 40-year-old woman diagnosed with ductal carcinoma in situ. The initial mammographic image (A) shows grouped, amorphous, and punctate calcifications, which are considered probably benign and are categorized as BI-RADS category 3 by the initial radiologist, but are retrospectively re-categorized as BI-RADS category 4a (group B). A subsequent mammographic image with a magnified view (B) acquired after 13 months shows an increase in the extent of fine pleomorphic and linear branching calcifications, which are re-categorized as BI-RADS category 4b. BI-RADS = Breast Imaging Reporting and Data System

• 

  Fig. 3 Flow chart of change in the BI-RADS assessment category in groups A and B. BI-RADS = Breast Imaging Reporting and Data System

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