title: A matrix of morphology and distribution of calcifications in the breast: Analysis of 849 vacuum-assisted biopsies.
abstract: OBJECTIVE
  The purpose of this retrospective analysis was to evaluate the likelihood of malignancy in prospectively categorized BI-RADS 4 and BI-RADS 5 calcifications.
  
  
  METHODS
  This analysis included 849 women who underwent vacuum biopsy for BI-RADS 4 (with the subgroups 4A, 4B and 4C) or BI-RADS 5 calcifications between February 2007 and May 2015. Calcifications were classified according to the morphology and distribution descriptors of the BI-RADS lexicon (BI-RADS 4th edition lexicon). A standardized scheme (matrix) was used to combine the characteristics of the grouped calcifications with the BI-RADS assessment category.
  
  
  RESULTS
  Overall, 275/849 (32%) lesions were found to be malignant. 285/327/208/29 calcified lesions were prospectively classified as BI-RADS 4A/4B/4C/5 indicating a risk for malignancy of 16%/27%/55%/90%, respectively. The morphology descriptors predicted the risk for malignancy as follows: typically benign (n=55): 2%; indeterminate (n=676): 27%; typically malignant (n=118): 80%. The distribution descriptors correlated with a malignant histology as follows: diffuse (n=0); round or oval (n=261): 22%; regional (n=398): 33%; segmental (n=106): 42%; linear or branching (n=85): 55%. There was a significant difference between the descriptor categories (p<0.0001).
  
  
  CONCLUSIONS
  A standard scheme combining the morphology and distribution characteristics proved to be a helpful tool in diagnosis of calcifications, bridging the gap between description and classification of these lesions.
authors.affiliation: Institute of Radiology (RZI), Klinikum Frankfurt/Main - Höchst, Academic Teaching Hospital of the University of Frankfurt/Main, Germany; Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany. Electronic address: benjamin.kaltenbach@kgu.de.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kaltenbach
authors.affiliation: Diagnostic Breast Center Turmcarée, Mammography Screening, Frankfurt/Main, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Brandenbusch
authors.affiliation: Department of Obstetrics and Gynecology, Klinikum Frankfurt/Main-Höchst, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Möbus
authors.affiliation: Institute of Pathology, Klinikum Frankfurt/Main-Höchst, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Mall
authors.affiliation: OptiPath, Pathology Associates, Frankfurt/Main, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Falk
authors.affiliation: Asthenis, Medical Data Management, Aschheim, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: van den Bergh
authors.affiliation: Institute of Radiology (RZI), Klinikum Frankfurt/Main - Höchst, Academic Teaching Hospital of the University of Frankfurt/Main, Germany.
authors.forename: Frauke
authors.initials: F
authors.lastname: Chevalier
authors.affiliation: Institute of Radiology (RZI), Klinikum Frankfurt/Main - Höchst, Academic Teaching Hospital of the University of Frankfurt/Main, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Müller-Schimpfle
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D002114:Calcinosis / Q000473:pathology*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D014618:Vacuum
keywords: Breast carcinoma; Calcifications; Ductal carcinoma in situ; Vacuum biopsy