title: Impact of magnification views on the characterization of microcalcifications in digital mammography.
abstract: OBJECTIVE
  To evaluate the additional benefit of true geometric (air-gap) magnification views for the characterization of microcalcifications in digital mammography.
  
  
  METHODS
  After ethical approval, we retrospectively reviewed patient records to identify 100 patients with suspicious microcalcifications (35 malignant, 65 benign) who had a standard digital mammography and an additional digital magnification view in the same projection within three months. All images were obtained using an amorphous silicon-based full-field digital system (Senographe 2000 D, GE Healthcare, Chalfont St. Giles, UK). Images were independently analyzed by six board-certified radiologists. The probability of malignancy was estimated using first standard contact mammography alone (MG) and then mammography in combination with the magnification view (MG+MAG) using a modified Breast Imaging Reporting and Data System (BI-RADS) classification system and a percentage scale. Results were compared using receiver operating characteristic (ROC) analysis. In addition, readers assessed the subjective visibility of the calcifications.
  
  
  RESULTS
  For all six readers combined, the area under the curve (AUC) was 0.664 ± 0.052 for MG and 0.813 ± 0.042 for MG + MAG, resulting in a statistically significant improvement of 0.148 ± 0.120. Each reader had a higher AUC for MG + MAG than MG, with the improvement being statistically significant in four of the six readers. In 76.34 % of the cases, MG + MAG resulted in better visibility of calcifications compared with mammography alone. In 33 % slightly more and in 39 % significantly more calcifications were found.
  
  
  CONCLUSIONS
  Even in digital mammography with the option of using electronic magnification (zoom) at the viewing workstation, true geometric (air-gap) magnification views remain important for the visibility and correct classification of microcalcifications and for the assessment of their extent.
authors.affiliation: Clinic of Radiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin, Berlin.
authors.forename: E M
authors.initials: EM
authors.lastname: Fallenberg
authors.affiliation: Institute of diagnostic and interventional Radiology, DRK-Kliniken Berlin-Mitte, Berlin.
authors.forename: L
authors.initials: L
authors.lastname: Dimitrijevic
authors.affiliation: Department of Medical Imaging, St. Joseph-Stift, Bremen.
authors.forename: F
authors.initials: F
authors.lastname: Diekmann
authors.affiliation: Neuroimaging for Research, Berlin.
authors.forename: S
authors.initials: S
authors.lastname: Diekmann
authors.affiliation: Reference-Centre of Mammography-Screening, Berlin.
authors.forename: U
authors.initials: U
authors.lastname: Kettritz
authors.affiliation: Clinic of Radiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin, Berlin.
authors.forename: A
authors.initials: A
authors.lastname: Poellinger
authors.affiliation: Department of Radiology, Campus Charité Mitte, Charité - Universitätsmedizin, Berlin.
authors.forename: U
authors.initials: U
authors.lastname: Bick
authors.affiliation: Breast Center, Department of Gynecology, Campus Charité Mitte, Charité - Universitätsmedizin, Berlin.
authors.forename: K J
authors.initials: KJ
authors.lastname: Winzer
authors.affiliation: Department of Radiology, Campus Charité Mitte, Charité - Universitätsmedizin, Berlin.
authors.forename: F
authors.initials: F
authors.lastname: Engelken
authors.affiliation: Clinic of Radiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin, Berlin.
authors.forename: D M
authors.initials: DM
authors.lastname: Renz
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015984:Causality; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods*; D018570:Risk Assessment