Keywords:
Performed at one institution, Observational, Retrospective, Neoplasia, Cancer, Calcifications / Calculi, Biopsy, Mammography, Oncology, Breast
Authors:
M. Talanyan, N. Mashuryan, S. Grigoryan; Yerevan/AM
DOI:
10.26044/ecr2020/C-04844
Methods and materials
There are many tools and tests for finding and diagnosing breast cancer. For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. Histopathology remains as the gold standard.
Vacuum assisted breast biopsy is a safe and minimally invasive procedure in which a sample of breast tissue is removed for pathology examination. VABB has a lot of advantages; it is used to reduce sampling error, decrease the re-biopsy rate, decreased patient pain and anxiety and reduce the recovery time.
Calcifications are very common, present in ~85% of mammograms. Their frequency increases with age. There are a lot of varieties of calcifications that can be detected in the breast tissue and they can be found within the ductal system, the breast acini, stroma, and vessels. They can be benign and suspicious. Most calcifications in the breast are benign type. VABB is usually performed in cases with suspicious calcifications, which were detected by initial mammograms. When we discover the calcifications by mammograms, we should pay attention to their size, form, density, number, and distribution. Most calcifications in the breast are benign type.
Benign
- Skin – These have a lucent center, usually tightly grouped and situated in the skin. These are better seen on the tangential view.
- Vascular – These are formed in blood vessel walls, have a discontinuous linear appearance and described as railroad track calcifications.
- Popcorn – These are formed in involuting fibroadenomas and have a larger size, >2-3mm.
- Plasma Cell mastitis – These are rod-like calcifications, formed within ectatic ducts. The calcifications can be located around the dilated ducts, inside the lumen or in the duct wall, usually > 1mm in diameter and seen in older women (>60 years).
- Round - 0,5-1,0 mm in size and frequently formed in the acini of the terminal duct lobular unit.
- Punctate – the same as round, but <0,5mm.
- Lucent-centered – These are very thin benign rim calcifications that appear as calcium deposited on the surface of a sphere, very alike eggshell calcifications, which are usually caused by hemorrhage within a spherical or ovoid lesion, which can be oil cysts (fat necrosis), simple cysts of fibroadenomas.
- Milk of calcium – These are benign calcium deposits in macro- or microcysts and seen as tiny, teacup-shaped calcifications situated within the cysts.
- Dystrophic – These are irregular 'lava-shaped' calcifications. Usually, >5mm and have a lucent center. Often seen in the breast after radiation, trauma or surgery.
- Suture – These are linear or tubular calcium deposits on suture material.
Suspicious
- Amorphous – These calcifications don’t have clearly defined shape or form. They can be described as “powdery”, “cloud”, “hazy” or “cottony”.
- Coarse heterogeneous – These are irregular, conspicuous calcifications that are generally >0.5mm.
- Fine linear – These are thin, linear or curvilinear irregular calcifications usually <0,5mm. They may be discontinuous or irregularly arranged.
- Fine linear branching – the linear calcifications that are arrayed in branches.
- Fine pleomorphic – These are varying in size and shape (“shards of glass” or “crushed stone”), and are usually <0,5mm in diameter.
Also, the distribution of the calcifications can determine their probable type.
Benign
- Diffuse – equal distribution over the breast parenchyma
- Regional – scattered in >2cm in breast tissue and not related to the ductal system
Suspicious
- Clustered – distribution of calcifications is restricted to an area of 1 cm2
- Linear – calcifications arrayed in a line suggestive of deposition along the ducts, typically oriented toward the nipple; can be a linear distribution with additional branching
- Segmental – calcifications in the ducts and branches of a segment or lobe
The mammographic features of the lesions that were subjected to stereotactic VABB were mostly clustered microcalcifications. Microcalcifications visible on mammographic images are defined as calcium oxalate and calcium phosphate deposits of size below 1mm. During this procedure, a needle is guided to the location with the help of mammography. A small titanium clip is usually put into the breast to mark where the biopsy sample was taken, in case the tissue is cancerous and more surgery is needed.
The data were collected from the electronic database and patients’ medical records in the radiology department of “Astghik” MC, Yerevan from May 2016 - December 2019. In most of the cases, the clinical diagnosis was BI-RADS 4 lesions.