title: Evaluation of breast amorphous calcifications by a computer-aided detection system in full-field digital mammography.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the performance of a direct computer-aided detection (d-CAD) system integrated with full-field digital mammography (FFDM) in assessment of amorphous calcifications.
  
  
  METHODS
  From 1438 consecutive stereotactic-guided biopsies, FFDM images with amorphous calcifications were selected for retrospective evaluation by d-CAD in 122 females (mean age, 56 years; range, 35-84 years). The sensitivity, specificity, accuracy and false-positive rate of the d-CAD system were calculated in the total group of 124 lesions and in the subgroups based on breast density, mammographic lesion distribution and extension. Logistic regression analysis was used to stratify the risk of malignancy by patient risk factors and age.
  
  
  RESULTS
  The d-CAD marked all (36/36) breast cancers, 85% (11/13) of the high-risk lesions and 80% (60/75) of benign amorphous calcifications (p<0.01) correctly. The sensitivity, specificity and diagnostic accuracy for the combined malignant and "high-risk" lesions was 96, 80 and 86%, respectively. The likelihood of malignancy was 29%. There was no significant difference between the marking of fatty or dense breasts (p>0.05); however, d-CAD marks showed differences for small (<7 mm) lesions (p=0.02) and clustered calcifications (p=0.03). The false-positive rate of d-CAD was 1.76 marks per full examination.
  
  
  CONCLUSIONS
  The d-CAD system correctly marked all biopsy-proven breast cancers and a large number of biopsy-proven high-risk lesions that presented as amorphous calcifications. Given our 29% likelihood of malignancy, imaging-guided biopsy appears to be a reasonable recommendation in cases of amorphous calcifications marked by d-CAD.
authors.affiliation: Department of Medical Imaging, Princess Margaret Hospital, University Health Network, University of Toronto, ON, Canada. anabel.scaranelo@uhn.on.ca
authors.forename: A M
authors.initials: AM
authors.lastname: Scaranelo
authors.forename: R
authors.initials: R
authors.lastname: Eiada
authors.forename: K
authors.initials: K
authors.lastname: Bukhanov
authors.forename: P
authors.initials: P
authors.lastname: Crystal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001941:Breast Diseases / Q000000981:diagnostic imaging*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity