title: Breast microcalcifications as type descriptors to stratify risk of malignancy: a systematic review and meta-analysis of 10665 cases with special focus on round/punctate microcalcifications.
abstract: OBJECTIVE
  To use a systematic review and meta-analysis to determine the predictive value of five suspicious type descriptors of microcalcifications, with special focus on round/punctate microcalcifications because of controversy.
  
  
  METHODS
  We performed a literature search using three databases and one search engine. We screened citations for malignancy rates of type descriptors. We regarded malignancy rates below 2% (BI-RADS 3) and above 95% (BI-RADS 5) as clinically significant threshold values for suspicion (BI-RADS 4).
  
  
  RESULTS
  Forty studies from 14 countries with a total of 10,665 microcalcification lesions were included. The pooled malignancy rates were: coarse heterogeneous, 13% (95% confidence interval (95%-CI): 7 - 20%); amorphous or indistinct, 27% (95%-CI: 21-33%); pleomorphic, 50% (95%-CI: 43-58%); linear, 78% (95%-CI: 68 - 86%). The pooled malignancy rate of all round/punctate microcalcifications was 9% (95%-CI: 6-13%), for the subgroup follow-up it was 0,5% (95%-CI: 0.08-2.57%), and with histological verification it was 14% (95%-CI: 11-19%). Woman selection and consideration of additional suspicious image findings were reasons for between-study heterogeneity. Addition of ACR distribution descriptors diversified risk stratification, but did not alter BI-RADS assessment category.
  
  
  CONCLUSIONS
  All suspicious type descriptors including round/punctate microcalcifications as well as combinations of type with suspicious distribution descriptors fell into BI-RADS assessment category 4. Exclusion of suspicious adjunct factors can direct clustered, round/punctate microcalcifications to a lower BI-RADS assessment category.
authors.affiliation: Klinik für Strahlendiagnostik, Klinikum der Philipps-Univ. Marburg, Marburg, Germany. rominger@med.uni-marburg.de
authors.forename: M
authors.initials: M
authors.lastname: Rominger
authors.forename: C
authors.initials: C
authors.lastname: Wisgickl
authors.forename: N
authors.initials: N
authors.lastname: Timmesfeld
mesh_terms: D001706:Biopsy; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D002114:Calcinosis / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000379:methods*; D011237:Predictive Value of Tests; D011336:Probability