[Ultrasound examination of breast microcalcifications: luxury or necessity?].
OBJECTIVE
Determine the value of ultrasound for the diagnosis of isolated breast microcalcifications.


METHODS
Fifty clusters of microcalcifications, including 25 smaller than 10 mm, were examined by ultrasound (5-13 MHz) prior to stereotactic aspiration macrobiopsy (30 benign lesions, three borderline lesions, and 17 malignant lesions, including ten in situ lesions and seven invasive lesions). Mammography had placed 13 of these cases in BI-RADS 3, 24 in BI-RADS 4, and 13 in BI-RADS 5. The BI-RADS classification was also used for ultrasound assessment.


RESULTS
Six of the 18 microcalcifications that were not seen by ultrasound were malignant (two invasive ductal cancers [IDC] and four ductal carcinomas in situ [DCIS]). Two of the four cases with no sonographically visible tissue mass proved to be malignant (one IDC, one DCIS); these two lesions had been classified BI-RADS 4 and 5 by mammography and were larger than 10 mm. Ultrasound visualized 16 masses classed BI-RADS 3, ten masses classed BI-RADS 4, and two masses classed BI-RADS 5. One of the lesions classified as BI-RADS 3 by mammography was an IDC that was classed BI-RADS3 by ultrasound. Four of the lesions classed BI-RADS 4 by mammography were malignant (three were classified BI-RADS3 by ultrasound while one was classed BI-RADS4). One benign lesion was classified BI-RADS 5 by ultrasound. Four cancers were mammographically classed BI-RADS 5; ultrasound was in agreement in one case but classed three of the cases as BI-RADS 4. In one case, ultrasound gave a diagnosis of benignity (BI-RADS 3 classification).


CONCLUSIONS
Ultrasound is unsuited for the diagnosis of microcalcifications because it fails to visualize a mass in one-third of cancers and the existence of a mass is correlated with malignancy in one-third of cases. Furthermore, US does not correct the false-negative errors of mammography, and it underestimates the rate of malignancy by ascribing a benign appearance to 50% of cancers, which mammography correctly classifies BI-RADS 4 or 5.
Balu-Maestro
C
C
Centre Antoine-Lacassagne, Service de Radiologie, 33 Avenue de Valombrose, 06189 Nice Cedex 01. catherine.maestro@nice.fnclcc.fr
Chapellier
C
C
Ben Taaritt
I
I
Fournol
M
M
D001941:Breast Diseases / Q000000981:diagnostic imaging*; D002114:Calcinosis / Q000000981:diagnostic imaging*; D006801:Humans; D008327:Mammography; D011446:Prospective Studies; D014463:Ultrasonography