Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy.
OBJECTIVE
To retrospectively evaluate whether microcalcification descriptors and the categorization of microcalcification descriptors in the Breast Imaging Reporting and Data System (BI-RADS) 4th edition help stratify the risk of malignancy, by using biopsy and clinical follow-up as reference standards.


METHODS
The institutional review board approved this HIPAA-compliant study and waived informed consent. The study included 115 women (age range, 26-82 years; mean age, 55.8 years +/- 10.5 [standard deviation]) who consecutively underwent image-guided biopsy of microcalcifications between November 2001 and October 2002. Screening and diagnostic mammograms (including magnification views) obtained before biopsy were analyzed in a blinded manner by a subspecialty-trained breast imager who recorded BI-RADS descriptors on a checklist. The proportion of malignant cases was used as the outcome variable to evaluate the ability of the descriptors to help capture the risk of malignancy. Fisher exact test was used to calculate the difference among the individual descriptors and descriptor categories.


RESULTS
The positive predictive value of biopsy for malignancy was 21.7%. Each calcification morphologic descriptor was able to help stratify the probability of malignancy as follows: coarse heterogeneous, one (7%) of 14; amorphous, four (13%) of 30; fine pleomorphic, 10 (29%) of 34; and fine linear, 10 (53%) of 19. Fisher exact test results revealed a significant difference among these descriptor categories (P = .005). Significant differences among the risks suggested by microcalcification distribution descriptors (P = .004) and between that of stability descriptors (P = .001) were found.


CONCLUSIONS
The microcalcification descriptors and categories in BI-RADS 4th edition help predict the risk of malignancy for suspicious microcalcifications.
Burnside
Elizabeth S
ES
Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252, USA. EBurnside@uwhealth.org
Ochsner
Jennifer E
JE
Fowler
Kathryn J
KJ
Fine
Jason P
JP
Salkowski
Lonie R
LR
Rubin
Daniel L
DL
Sisney
Gale A
GA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002114:Calcinosis / Q000145:classification / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D018570:Risk Assessment; D016037:Single-Blind Method; D025321:Surgery, Computer-Assisted; D009626:Terminology as Topic