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Year : 2002  |  Volume : 12  |  Issue : 1  |  Page : 33-36
Pictorial essay : Breast calcification


Department of Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences, Lucknow Road, Delhi-110054, India

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Keywords: Calcification, mammogram

How to cite this article:
Popli M. Pictorial essay : Breast calcification. Indian J Radiol Imaging 2002;12:33-6

How to cite this URL:
Popli M. Pictorial essay : Breast calcification. Indian J Radiol Imaging [serial online] 2002 [cited 2019 Jul 17];12:33-6. Available from: http://www.ijri.org/text.asp?2002/12/1/33/28414
Calcium deposits are extremely common in the breast. Calcifications are found in 8-10% of mammograms performed for women between the ages of 25 and 29 with a steady increase to 86% of the mammograms performed on women between the age of 76 and 79 years. The great majority of these calcifications are benign. Typical calcifications are also seen in breast cancer which is just one of the many processes that result in calcium deposition. Calcium deposits are produced by active cell secretion or they form in necrotic cell debris; they may be a response to inflammation, trauma, radiation or foreign bodies. Calcifications are found within the ducts, alongside and around the ducts, in the lobular acini, in vascular structures, in the interlobular stroma, in fat and in the skin. Depending on their etiology and location they may be punctate, branching, linear, spherical, fine, coarse, regular in size and shape, or heterogeneous. Most of these radiopaque deposits contain calcium in the form of calcium hydroxyapatite and tricalcium phosphate. It has been suggested by some workers that these calcifications contain an array of heavy metals and may not be exclusively composed of calcium derivatives.

The morphology and distribution of breast calcifications can often indicate their etiology. Certain patterns are never associated with malignancy. Common types of typical calcifications are:

  1. Vascular Calcifications within arterial walls due to athero- sclerosis produces the characteristic pattern of two parallel calcific lines: 'Train Track' appearance [Figure - 1]. As with most arterial deposits, these are calcifications in the intima of the arterial wall.
  2. Large, linear, solid, rod shaped calcifications conforming to the lumen of the duct are benign if they are solid and continuous without branching. These thick (greater than 0.5 mm in diameter) rods are the result of calcification of the debris that has collected in the duct. The process has been named 'Secretory disease' [Figure - 2],[Figure - 3]. However if the linear calcifications are very small and linear distribution is with branching, the possibility of ductal carcinoma-in-situ should be considered.
  3. Lucent centered calcifications are always due to a benign process and may represent secretory deposits, areas of fat necrosis, or may be in the skin and not in the breast itself [Figure - 4],[Figure5].
  4. Fibroadenomas calcify as they undergo myxoid degeneration. Early calcification in a fibroadenoma frequently occurs at the periphery of the mass. Popcorn calcifications are typical of an involuting fibroadenoma [Figure - 6]. Large, irregularly shaped calcifications always indicate an involuting fibroadenoma [Figure7].
  5. Thin rim calcifications usually delineate the wall of a cyst. Calcifications confirming to the wall of the sphere are due to a benign process. Sometimes the whole cyst may get calcified [Figure - 8],[Figure9]. Atypical irregular rim calcifications are probably associated with intraductal papilloma [Figure - 10]
  6. Small pin point deposits, Punctate calcifications, are seen in fibrous stroma with no apparent etiology [Figure - 11],[Figure - 12].
  7. Five or more calcifications, measuring less than one millimeter, in a volume of one cubic centimeter, define a 'cluster'. The possibility of malignancy increases as the size of the individual calcification decreases, the total number of calcifications per limit area increases and the risk increases when they are heterogeneous in size and shape [Figure - 13].
  8. Calcifications that occupy a large volume of tissue, but not the entire breast are termed 'regionally distributed'. Benign forms of calcification tend to have similar shapes. But if the particles are pleomorphic and dense for their small size, cancer is likely [Figure - 14].
  9. Palpable lump in the region of the axillary tail may turn out to be enlarged calcified nodes on mammography [Figure - 15][7].


 
   References Top

1.Olson L, Fam BW, Winter PF, Scholz FJ, Lee AK, Gordon SE. Breast calcifications: Analysis of imaging properties. Radiology 1988; 169: 329-332.  Back to cited text no. 1    
2.Parker MD, Clark RL, McLelland R, Daughtery K. Disappearing breast calcifications. Radiology 1989; 172:677-680.   Back to cited text no. 2  [PUBMED]  
3.Bassett. LW (1992) Mammographic analysis of calcifications. Rad Clin N Am 1992: 93- 105.   Back to cited text no. 3    
4.Patrick EA, Moskowitz M, Mansukhani VT and Gruenstein EA Expert learning system network for di-agnosis of breast calcifications. Investigative Radiology 1991; 534-539.   Back to cited text no. 4    
5.Shen L, Rangayyan RM and Desautels JE (1993) Detection and classification of mammographic calcifications. International Journal of Pattern Recognition and Machine Intelligence 1993; 1403-1416.   Back to cited text no. 5    
6.Thomas, D. et al. Mammographic calcifications and risk of subsequent breast cancer. J Nat Cancer Inst 1993, 85:230-234.   Back to cited text no. 6    
7.Kallergi M, Gavrielides MA, He L, Berman CG, Kim JJ, and Clark RA. A simulation model of mammographic calcifications based on the ACR BIRADS. Academic Radiology 1998; 5:670-679.   Back to cited text no. 7    

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Correspondence Address:
M Popli
Department of Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences, Lucknow Road, Delhi-110054
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10], [Figure - 11], [Figure - 12], [Figure - 13], [Figure - 14], [Figure - 15]

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