Intermediate to highly suspicious calcification in breast lesions: A radio-pathologic correlation

Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Ngan Shing Street, Shatin, NT, Hong Kong SAR.
Breast Cancer Research and Treatment (Impact Factor: 3.94). 08/2008; 110(1):1-7. DOI: 10.1007/s10549-007-9695-4
Source: PubMed


Breast calcification is an important feature in the radiological assessment of breast lesions. There are well established diagnostic criteria basing on the morphology and distribution of the calcifications radiologically with recommendation protocols. Pathologically, calcifications in breast lesions are of dystrophic type, and may occur in either the secretory materials or necrotic debris, with inflammation and osteopontin being plausible mediators. Detection of calcium phosphate (hydroyapaptite) is considerably easier than calcium oxalate. Radiologically amorphous calcification represents a borderline type of calcification, and occurs in both benign and malignant (low grade) lesions, and warrants careful follow up and investigation. Clustering of calcification alone may not be an accurate predictor for malignancy, but when there are associated features like pleomorphism, branching, architectural distortion, and associated mass or density, the predictive value for malignant increases. Adequate sampling of calcification in the biopsy is crucial in the management of patients; in general, needle core biopsy or mammotome biopsy achieve satisfactory calcification retrieval. In a benign biopsy that fails to identify the calcifications visible in the mammography, further evaluation or cutting of the histologic block is recommended to minimize the potential of a false negative investigation.

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    • "Because calcium and vitamin D intake were associated with mechanisms of carcinogenesis of the mammary gland,81,82 and in addition, breast calcifications are an important risk factor for BC,83 Zhang et al84 evaluated the role of miRSNPs within the 3′-UTR of RYR3, a CICR (calcium-induced calcium release) protein playing a crucial role in cellular Ca2+ homeostasis. After the analysis of 1,532 breast cancer cases and 1,600 healthy Chinese women, rs1044129 was found to be associated with BC risk, calcification, and progression-free survival. "
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    • "The standard craniocaudal and lateral views were carried out in all patients. Mammographic findings requiring further exploration with breast biopsy were considered the following: (1) microcalcifications; (2) mass with or without microcalcifications; (3) architectural distortion with or without microcalcifications; and (4) asymmetric density with the greater diameter < 1 cm with or without microcalcifications [10]. Based on published observations, we evaluated MAMCs according to their shape (e.g. "
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    • "However, it may also be possible that the total mineral content is greater in calcifications of benign lesions. Benign calcifications are typically described as being more crystalline, although this also includes examination of type I (calcium oxalate) calcifications (Tse et al, 2007). The fact that the nature of calcifications (carbonate content and matrix : mineral ratios) in DCIS pathology, appears to lie consistently between benign and invasive types, indicates that benign tissue calcifications (consisting of fibroadenoma, ductal hyperplasia and fibrocystic change) are likely to lead to a DCIS, which in turn will result in invasive disease. "
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