title: Improved Diagnostics by Assessing the Micromorphology of Breast Calcifications via X-Ray Dark-Field Radiography.
abstract: Breast microcalcifications play an essential role in the detection and evaluation of early breast cancer in clinical diagnostics. However, in digital mammography, microcalcifications are merely graded with respect to their global appearance within the mammogram, while their interior microstructure remains spatially unresolved and therefore not considered in cancer risk stratification. In this article, we exploit the sub-pixel resolution sensitivity of X-ray dark-field contrast for clinical microcalcification assessment. We demonstrate that the micromorphology, rather than chemical composition of microcalcification clusters (as hypothesised by recent literature), determines their absorption and small-angle scattering characteristics. We show that a quantitative classification of the inherent microstructure as ultra-fine, fine, pleomorphic and coarse textured is possible. Insights underlying the micromorphological nature of breast calcifications are verified by comprehensive high-resolution micro-CT measurements. We test the determined microtexture of microcalcifications as an indicator for malignancy and demonstrate its potential to improve breast cancer diagnosis, by providing a non-invasive tool for sub-resolution microcalcification assessment. Our results indicate that dark-field imaging of microcalcifications may enhance the diagnostic validity of current microcalcification analysis and reduce the number of invasive procedures.
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Frank-Straße, Garching, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Scherer
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Frank-Straße, Garching, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Braig
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Frank-Straße, Garching, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ehn
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Frank-Straße, Garching, Germany.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Schock
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Frank-Straße, Garching, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Wolf
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Frank-Straße, Garching, Germany.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Birnbacher
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Frank-Straße, Garching, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Chabior
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Frank-Straße, Garching, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Herzen
authors.affiliation: Department of Pathology, Ludwig Maximilian University, Thalkirchner Straße, Munich, Germany.
authors.forename: Doris
authors.initials: D
authors.lastname: Mayr
authors.affiliation: Department of Clinical Radiology, Ludwig Maximilian Universität, Marchioninistraße, Munich, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Grandl
authors.affiliation: Department of Clinical Radiology, Ludwig Maximilian Universität, Marchioninistraße, Munich, Germany.
authors.forename: Anikó
authors.initials: A
authors.lastname: Sztrókay-Gaul
authors.affiliation: Department of Clinical Radiology, Ludwig Maximilian Universität, Marchioninistraße, Munich, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Hellerhoff
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Frank-Straße, Garching, Germany.
authors.forename: Franz
authors.initials: F
authors.lastname: Pfeiffer
mesh_terms: D001940:Breast / Q000000981:diagnostic imaging*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008327:Mammography; D055114:X-Ray Microtomography