Breast Microcalcifications: Multivariate Analysis of Radiologicand Clinical Factors for Carcinoma

Abstract

Screening mammography contributes to theimprovement of breast carcinoma survival through early detection andtreatment of non-palpable lesions. Microcalcifications are offundamental importance in this process. The percentage of malignantlesions found in biopsies for microcalcifications varies from 10% to40%. The purpose of this study was to evaluate the relationshipbetween clinical and radiologic records and the presence of malignantbreast diseases. To establish the basis for the study, 211 mammographicfiles showing clustered microcalcifications from 204 women wereprospectively reviewed and clinical records were retrospectively drawn.Definitive pathologic analysis was available for all. The value forcancer of each criterion was investigated by univariate andmultivariate analyses. A first analysis was performed on the entirepopulation and a second one was performed with stratification onmorphologic subgroups. There were 99 malignant lesions (47%). In theentire group, no clinical criterion was significant. In the univariateanalysis, five radiologic variables were significant: morphologic type(p < 0.0001), number of calcifications per cluster(p < 0.0001), linear or triangular distribution(p < 0.0002), diameter of the area (p < 0.01),and number of clusters (p = 0.011). In themultivariate analysis, two criteria remained significant: morphologictype 4 (irregularly punctiform) or 5 (vermicular) microcalcifications(Le Gal’s classification) (p < 0.0001) and diameter of thecluster larger than 25 mm (p = 0.032). In subgroups,in the multivariate analysis, the "age > 60 years" criterion wasstatistically significant in the group of regular punctiformmicrocalcifications (type 2); for irregularly punctiformmicrocalcifications (type 4), "number of microcalcifications > 20" was significant. The morphologic features of microcalcifications mustbe the first criterion evaluated. They permit identification ofcharacteristically benign (annular calcifications) or malignantcalcifications (vermicular calcifications). For the remainder of thecalcification types, other criteria must be taken into account, and their value vary with (according to) themorphologic aspect. These findings have implications for the managementof women with microcalcifications and could help breast specialistsmake treatment decisions.