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KMID : 1103720170760040251
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Journal of the Korean Society of Radiology
2017 Volume.76 No. 4 p.251 ~ p.258
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Retrospective Analysis on Malignant Calcification Previously Misdiagnosed as Benign on Screening Mammography
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Ha Su-Min
Cha Joo-Hee
Kim Hak-Hee
Shin Hee-Jung
Chae Eun-Young
Choi Woo-Jung
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Abstract
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Purpose: The purpose of our study was to investigate the morphology and distribution of calcifications initially interpreted as benign or probably benign, but proven to be malignant by subsequent stereotactic biopsy, and to identify the reason for misinterpretation or underestimation at the initial diagnosis.
Materials and Methods: Out of 567 women who underwent stereotactic biopsy for calcifications at our hospital between January 2012 and December 2014, 167 women were diagnosed with malignancy. Forty-six of these 167 women had previous mammography assessed as benign or probably benign which was changed to suspicious malignancy on follow-up mammography. Of these 46 women, three women with biopsy-proven benign calcifications at the site of subsequent cancer were excluded, and 43 patients were finally included. The calcifications (morphology, distribution, extent, associated findings) in the previous and follow-up mammography examinations were analyzed according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon and assessment category. We classified the patients into two groups: 1) group A patients who were still retrospectively re-categorized as less than or equal to BI-RADS 3 and 2) group B patients who were re-categorized as equal to or higher than BI-RADS 4a and whose results should have prompted previous diagnostic assessment.
Results: In the follow-up mammography examinations, change in calcification morphology (n = 27, 63%) was the most frequent cause of assessment change. The most frequent previous mammographic findings of malignant calcification were amorphous morphology (n = 26, 60%) and grouped distribution (n = 36, 84%). The most frequent calcification findings at reassessment were amorphous morphology (n = 4, 9%), fine pleomorphic calcification (n = 30, 70%), grouped distribution (n = 23, 53%), and segmental calcification (n = 12, 28%). There were 33 (77%) patients in group A, and 10 patients (23%) in group B.
Conclusion: Amorphous morphology and grouped distribution were the most frequent mammographic findings of calcifications that were misinterpreted or underestimated by the initial radiologist and confirmed as malignancy at follow-up.
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KEYWORD
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Breast, Calcification, Mammography, Neoplasms
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