title: Occurrence and positive predictive value of additional nonmass findings for risk stratification of breast microcalcifications in mammography.
abstract: OBJECTIVE
  To assess the occurrence and positive predictive value of additional nonmass findings to stratify the risk of breast microcalcifications.
  
  
  METHODS
  This retrospective evaluation included 278 lesions with vacuum- or image-guided hook-wire biopsy for suspicious microcalcifications. The lesions were categorized into exclusive microcalcifications and microcalcifications with focal asymmetry, tubular density or architectural distortion (ie, nonmass findings). To evaluate the utility of additional nonmass findings for risk stratification, outcome variables were positive predictive values and odds ratios for malignancy and invasive carcinoma.
  
  
  RESULTS
  Forty-five of 278 microcalcification lesions (16%) were associated with nonmass findings: 28 focal asymmetries, 2 tubular densities, and 15 focal asymmetries in conjunction with tubular densities. Architectural distortion was observed in 28 of these cases. The odds ratio for additional nonmass findings relative to exclusive microcalcifications was 5.9 and was statistically significant (P < .00001). Architectural distortion was the most specific indicator for malignancy and invasiveness, with odds ratios of 6.5 (P = .0072) and 5.6 (P = .0214), respectively.
  
  
  CONCLUSIONS
  Microcalcifications with nonmass findings were less frequent than exclusive microcalcifications but were more predictive for malignancy. Architectural distortion demonstrated the highest risk of malignancy and invasiveness. Assessment of additional nonmass findings might be useful for further risk stratification of microcalcifications, indications for additional imaging, and pretreatment considerations.
authors.affiliation: Department of Radiology, Philipps University, Marburg, Germany. Electronic address: rominger@med.uni-marburg.de.
authors.forename: Marga B
authors.initials: MB
authors.lastname: Rominger
authors.forename: Eva V
authors.initials: EV
authors.lastname: Sax
authors.forename: Jens H
authors.initials: JH
authors.lastname: Figiel
authors.forename: Nina
authors.initials: N
authors.lastname: Timmesfeld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001941:Breast Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012306:Risk
keywords: Breast; Breast neoplasm; Ductal carcinoma in situ; Mammography; Microcalcifications