Search

Micro-computed tomography (micro-CT) is a non-destructive imaging technique that offers highly detailed, 3D visualizations of a target specimen. In the context of breast cancer, micro-CT has emerged as a promising tool for analyzing microcalcifications (MCs), tiny calcium deposits that can indicate at an early stage the presence of cancer. This review aimed to explore the current applications of micro-CT in analyzing breast MCs (ex vivo, animal models, and phantoms) and to identify potential avenues in scientific research. We followed PRISMA guidelines for scoping reviews, yielding 18 studies that met our criteria. The studies varied in their purposes: feasibility and optimization of micro-CT for breast cancer imaging and MC analysis/diagnosis, comparison with other imaging modalities, development of micro-CT scanners and processing algorithms, enhancement of MC detection through contrast agents, etc. In conclusion, micro-CT offers superior image quality and detailed visualization of breast tissue (especially tumor masses and MCs), surpassing traditional methods like mammography and approaching the level of detail of histology. It holds great potential to enhance our understanding of MC characteristics and breast pathologies when used as a supplementary tool. Further research will solidify its role in clinical practice and potentially expand its applications in breast cancer studies. [ABSTRACT FROM AUTHOR]

Background: Although surgical excisional biopsy provides robust diagnostic results, the ultrasound-assisted vacuum-assisted biopsy (VABB) offers an alternative for Asian candidates with dense breasts and lesions which cannot be approached by stereotactic biopsy. The study aims to investigate the efficacy of the ultrasound-assisted VABB for impalpable mammographic-detected lesions. Materials and Methods: A retrospective case-control study is conducted in a group of Taiwanese female patients who have impalpable breast lesions such as microcalcifications at screening mammography that are limited to BI-RADS category 4. Specifically, the lesions are categorized into three groups: 4a, 4b, and 4c and the histology from B2 through B5. The cases underwent ultrasound-assisted VABB and the controls had lumpectomies. The diagnostic accuracy, rate of discordance, excited tumor size, and the proportion of cancer cases is evaluated and compared using Fisher's exact test, Cohen's kappa test, chi-Square test, and the use of IBM SPSS statistical programs. Results: The histology of the majorities of the collected specimen is B2 benign fibrocystic changes (60–70%). In cases of patients who are diagnosed with breast cancer, most are ductal carcinoma in situ and early-stage diseases. The cancer risks for lesions categorized under BI-RADS 4a, 4b, and 4c, respectively, are consistent with clinical practice. Meanwhile, the diagnostic accuracy of VABB is similar to lumpectomy, as the histologic discordance rate did not differ significantly. Conclusions: Ultrasound-assisted VABB does offer an option for patients who are not candidates for stereotactic biopsy, as it has shown to have noninferior diagnostic values and cosmetic benefits when compared to surgical excision. The use of sonography monitors the biopsy process and guides the needle insertion, which is thus capable of obtaining samples from multiple directions, without risking the pectoralis muscles underneath. However, VABB may be intended for biopsies in lower-risk findings such as BI-RADS category 4a because doubts persist as complete excisional rates are operator-dependent. [ABSTRACT FROM AUTHOR]

Micro-computed tomography (micro-CT) is a non-destructive imaging technique that offers highly detailed, 3D visualizations of a target specimen. In the context of breast cancer, micro-CT has emerged as a promising tool for analyzing microcalcifications (MCs), tiny calcium deposits that can indicate at an early stage the presence of cancer. This review aimed to explore the current applications of micro-CT in analyzing breast MCs (ex vivo, animal models, and phantoms) and to identify potential avenues in scientific research. We followed PRISMA guidelines for scoping reviews, yielding 18 studies that met our criteria. The studies varied in their purposes: feasibility and optimization of micro-CT for breast cancer imaging and MC analysis/diagnosis, comparison with other imaging modalities, development of micro-CT scanners and processing algorithms, enhancement of MC detection through contrast agents, etc. In conclusion, micro-CT offers superior image quality and detailed visualization of breast tissue (especially tumor masses and MCs), surpassing traditional methods like mammography and approaching the level of detail of histology. It holds great potential to enhance our understanding of MC characteristics and breast pathologies when used as a supplementary tool. Further research will solidify its role in clinical practice and potentially expand its applications in breast cancer studies.

The aim of this study was to compare the characteristics of breast microcalcification on digital mammography (DM) with the histological and molecular subtypes of breast cancer and to identify the predictive value of DM and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing microcalcifications for radiologic–pathologic correlation. We relied on our prospectively maintained database of suspicious microcalcifications on DM, from which data were retrospectively collected between January 2020 and April 2023. We enrolled 158 patients, all of whom were subjected to biopsy. Additionally, 63 patients underwent breast DCE-MRI. Microcalcifications with a linear branched morphology were correlated with malignancies (p < 0.001), among which an association was highlighted between triple negatives (TNs) and segmental distribution (p < 0.001). Amorphous calcifications were correlated with atypical ductal hyperplasia (ADH) (p = 0.013), coarse heterogeneous (p < 0.001), and fine-pleomorphic (p = 0.008) with atypical lobular hyperplasia (ALH) and fine pleomorphic (p = 0.009) with flat epithelial atypia (FEA). Regarding DCE-MRI, no statistical significance was observed between non-mass lesions and ductal carcinoma in situ (DCIS). Concerning mass lesions, three were identified as DCIS and five as invasive ductal carcinoma (IDC). In conclusion, microcalcifications assessed in DM exhibit promising predictive characteristics concerning breast lesion subtypes, leading to a reduction in diagnostic times and further examination costs, thereby enhancing the clinical management of patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the characteristics of breast microcalcification on digital mammography (DM) with the histological and molecular subtypes of breast cancer and to identify the predictive value of DM and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing microcalcifications for radiologic–pathologic correlation. We relied on our prospectively maintained database of suspicious microcalcifications on DM, from which data were retrospectively collected between January 2020 and April 2023. We enrolled 158 patients, all of whom were subjected to biopsy. Additionally, 63 patients underwent breast DCE-MRI. Microcalcifications with a linear branched morphology were correlated with malignancies (p < 0.001), among which an association was highlighted between triple negatives (TNs) and segmental distribution (p < 0.001). Amorphous calcifications were correlated with atypical ductal hyperplasia (ADH) (p = 0.013), coarse heterogeneous (p < 0.001), and fine-pleomorphic (p = 0.008) with atypical lobular hyperplasia (ALH) and fine pleomorphic (p = 0.009) with flat epithelial atypia (FEA). Regarding DCE-MRI, no statistical significance was observed between non-mass lesions and ductal carcinoma in situ (DCIS). Concerning mass lesions, three were identified as DCIS and five as invasive ductal carcinoma (IDC). In conclusion, microcalcifications assessed in DM exhibit promising predictive characteristics concerning breast lesion subtypes, leading to a reduction in diagnostic times and further examination costs, thereby enhancing the clinical management of patients.

Abstract Background The purpose of this study was to evaluate the clinical performance of Digital Breast Tomosynthesis guided vacuum-assisted biopsy (DBT-VAB) for microcalcifications in the breast. Methods Retrospective review of 131 mammography-guided VABs at our institution were performed. All of the targets were calcification lesion suspicious for cancer. 45 consecutive stereotactic vacuum-assisted biopsies (ST-VABs) and 86 consecutive DBT-VABs were compared. Written informed consent was obtained. Tissue sampling methods and materials were the same with both systems. Student’s t-test was used to compare procedure time and the Fisher’s exact test was used to compare success rate, complications, and histopathologic findings for the 2 methods. Results The tissue sampling success rate was 95.6% for ST-VAB (43/45) and 97.7% (84/86) for DBT-VAB. Time for positioning (10.6 ± 6.4 vs. 6.7 ± 5.3 min), time for biopsy (33.4 ± 13.1 vs. 22.5 ± 13.1 min), and overall procedure time (66.6 ± 16.6 min vs. 54.5 ± 13.0 min) were substantially shorter with DBT-VAB (P

Background: The purpose of this study was to evaluate the clinical performance of Digital Breast Tomosynthesis guided vacuum-assisted biopsy (DBT-VAB) for microcalcifications in the breast. Methods: Retrospective review of 131 mammography-guided VABs at our institution were performed. All of the targets were calcification lesion suspicious for cancer. 45 consecutive stereotactic vacuum-assisted biopsies (ST-VABs) and 86 consecutive DBT-VABs were compared. Written informed consent was obtained. Tissue sampling methods and materials were the same with both systems. Student's t-test was used to compare procedure time and the Fisher's exact test was used to compare success rate, complications, and histopathologic findings for the 2 methods. Results: The tissue sampling success rate was 95.6% for ST-VAB (43/45) and 97.7% (84/86) for DBT-VAB. Time for positioning (10.6 ± 6.4 vs. 6.7 ± 5.3 min), time for biopsy (33.4 ± 13.1 vs. 22.5 ± 13.1 min), and overall procedure time (66.6 ± 16.6 min vs. 54.5 ± 13.0 min) were substantially shorter with DBT-VAB (P < 0.0001). There were no differences in the distribution of pathological findings between the 2 groups. Conclusion: Depth information and stable visibility of the target provided by DBT images led to quick decisions about target coordinates and improved the clinical performance of microcalcification biopsies. [ABSTRACT FROM AUTHOR]

Background: Although several studies proved that SM could substitute for FFDM, the efficacy of SM in microcalcification evaluation remains controversial. Aims: To investigate the diagnostic performance of synthetic mammography (SM) in the evaluation of microcalcifications in comparison with full-field digital mammography (FFDM). Methods: In this retrospective study, 76 mammograms of 76 patients who underwent FFDM and digital breast tomosynthesis (DBT) acquisitions concomitantly between 2018 and 2019 and whose final mammography interpretation revealed microcalcifications (28 malignant microcalcifications and 48 benign microcalcifications) were included. All mammograms were reviewed independently by three radiologists with different levels of breast imaging experience. Readers were blinded to patient outcomes and interpreted each case in two separate reading sessions (first FFDM, second SM + DBT), according to the BI-RADS lexicon. The area under the receiver operating characteristic (ROC) curve (AUC) was calculated using ROC analysis in all cases for FFDM and SM + DBT sessions. The readers also assigned conspicuity scores to mammograms. The interobserver agreement was calculated using intraclass correlation coefficients (ICC). Results: The overall AUCs for malignant microcalcifications were 0.80 (95% CI: 0.75–0.85) in FFDM and 0.85 (95% CI: 0.80–0.89) in SM, and no significant difference was found between the groups (p = 0.0603). The sensitivity of the readers increased slightly with experience. The ICC values of BI-RADS categorization between readers were 0.93 (95% CI: 0.90–0.95) and 0.94 (95% CI: 0.91–0.96) for FFDM and SM, respectively. Conclusions: SM had similar diagnostic performance in the evaluation of breast microcalcifications in comparison with FFDM, regardless of reader experience levels. [ABSTRACT FROM AUTHOR]

Micro-computed tomography (micro-CT) is a non-destructive imaging technique that offers highly detailed, 3D visualizations of a target specimen. In the context of breast cancer, micro-CT has emerged as a promising tool for analyzing microcalcifications (MCs), tiny calcium deposits that can indicate at an early stage the presence of cancer. This review aimed to explore the current applications of micro-CT in analyzing breast MCs (ex vivo, animal models, and phantoms) and to identify potential avenues in scientific research. We followed PRISMA guidelines for scoping reviews, yielding 18 studies that met our criteria. The studies varied in their purposes: feasibility and optimization of micro-CT for breast cancer imaging and MC analysis/diagnosis, comparison with other imaging modalities, development of micro-CT scanners and processing algorithms, enhancement of MC detection through contrast agents, etc. In conclusion, micro-CT offers superior image quality and detailed visualization of breast tissue (especially tumor masses and MCs), surpassing traditional methods like mammography and approaching the level of detail of histology. It holds great potential to enhance our understanding of MC characteristics and breast pathologies when used as a supplementary tool. Further research will solidify its role in clinical practice and potentially expand its applications in breast cancer studies.

Background Grouped microcalcifications are the tiny groupingofthemanycalcificationsseenonmammography.For pathological examination of mass-free clustered microcalcifications, amammography is considered because its visualization by conventional ultrasound is limited. Therefore, MicroPure imaging improves its detection and visualization. Objective This study aimed to evaluate the accuracy of MicroPure ultrasound in the diagnosis and characterization of breast microcalcifications with or without a mass in women undergoing-guided biopsies by ultrasound. Patients and methods Thirty women who were referred for breast imaging and diagnosis from Surgery and Oncology Departments to the Radiodiagnosis Department at Tanta Cancer Center were included in this study. Results In terms of diagnosis, 26 (86.7%) women had a mass, in two women (6.7%), amasswas discovered during screening andintwowomen(6.7%),amasswas discoveredduringfollowup. There were 26 (86.7%) women with a clustered distribution and four (13.3%)with a segmental distribution. Themean value of microcalcification detected by mammography was 12.87 ±6.64. Eleven women (36.7%) had benign masses and 19 (63.3%) had malignant masses. In terms of histopathology, 11 (36.7%) women were ductal carcinoma in situ, eight (26.7%) were invasive ductal carcinoma, six (20%) with distal hyperplasia without atypia, two (6.7%) with atypical ductal hyperplasia, two (6.7%) with sclerosing adenosis and one (3.3%) with fibroadenosis. Regarding ultrasound B (US B) mode, 17 (56.7%)womenwere visible and 13 (43.4%)were not visible. Regarding MicroPure, 25 (83.3%) women were visible and five (16.7%) were not visible. The mean value of microcalcification detected by MicroPure and US B mode are 8.8±6.61 and 5.97±6.7, respectively. Conclusions MicroPure scanning is a hopeful ultrasound tool that might enhance the sensitivity for diagnosis clustered microcalcifications which are not combined with breast mass on mammography. [ABSTRACT FROM AUTHOR]

Microcalcification is one of the significant indications for or can even be the sole mammographic feature of breast cancer, especially occult breast cancer. Biopsy and pathologic examination are the most important methods used to identify the nature of suspicious microcalcifications. Stereotactic vacuum-assisted breast biopsy (S-VAB) is the most commonly used biopsy method for microcalcifications currently because of the high detection rate of mammography for microcalcifications. However, in recent years, several clinical studies have gradually found that ultrasound-guided vacuum-assisted breast biopsy (US-VAB) could be an alternative to S-VAB for microcalcifications to some extent, and has its own advantages of flexibility, real-time performance, comfort and high accessibility compared with mammography. An overview of US-VAB of microcalcifications is provided with respect to success rate, diagnostic accuracy, advantages and limitations. On the basis of numerous studies and clinical experience, US-VAB proved to be a valid alternative to S-VAB, with comparable diagnostic accuracy if the microcalcification foci could be detected by ultrasound. And for patients with ultrasound-invisible microcalcifications who are not suitable for or tolerable of S-VAB, US-VAB combined with mammography localization of microcalcifications can also be considered. [ABSTRACT FROM AUTHOR]

The improvement of knowledge concerning the pathology of breast cancer could provide the rationale for the development of new imaging diagnostic protocols. Indeed, as for the microcalcifications, new histopathological markers can be used as target for in vivo early detection of breast cancer lesions by using molecular imaging techniques such as positron emission tomography. Specifically, the mutual contribution of these medical specialties can 'nourish' the dream of a personalized medicine that takes into account the intrinsic variability of breast cancer. In this review, we report the main discoveries concerning breast cancer pathology highlighting the possible cooperation between the departments of anatomic pathology and imaging diagnostics. [ABSTRACT FROM AUTHOR]

Wire localization of breast microcalcifications before surgical biopsy has been used for a long time. However, it causes patient's psychical trauma before operation with more cost of money and time as well. We design a noninvasive method using the concept of trigonometric function for preoperative localization. It can yield potential for cost-savings, increased efficacy in operating room and radiology scheduling, and patient comfort and convenience. Our method is simple and its failure rate is low.

Graphical abstract Abstract A preclinical murine model of hydroxyapatite (HA) breast microcalcifications (µcals), which are an important clinical biomarker for breast cancer detection, was used to investigate the independent effects of high affinity bisphosphonate (BP) ligands and a polyethylene glycol (PEG) spacer on targeted delivery of gold nanoparticles (Au NPs) for contrast-enhanced radiographic detection. The addition of BP ligands to PEGylated Au NPs (BP-PEG-Au NPs) resulted in five-fold greater binding affinity for targeting HA µcals, as expected, due to the strong binding affinity of BP ligands for calcium. Therefore, BP-PEG-Au NPs were able to target HA µcals in vivo after intramammary delivery, which enabled contrast-enhanced radiographic detection of µcals in both normal and radiographically dense mammary tissues similar to previous results for BP-Au NPs, while PEG-Au NPs did not. The addition of a PEG spacer between the BP targeting ligand and Au NP surface enabled improved in vivo clearance. PEG-Au NPs and BP-PEG-Au NPs were cleared from all mammary glands (MGs) and control MGs, respectively, within 24–48 h after intramammary delivery, while BP-Au NPs were not. PEGylated Au NPs were slowly cleared from MGs by lymphatic drainage and accumulated in the spleen. Histopathology revealed uptake of PEG-Au NPs and BP-PEG-Au NPs by macrophages in the spleen, liver, and MGs; there was no evidence of toxicity due to the accumulation of NPs in organs and tissues compared with untreated controls for up to 28 days after delivery. Statement of Significance Au NP imaging probes and therapeutics are commonly surface functionalized with PEG and/or high affinity targeting ligands for delivery. However, direct comparisons of PEGylated Au NPs with and without a targeting ligand, or ligand-targeted Au NPs with and without a PEG spacer, on in vivo targeting efficiency, biodistribution, and clearance are limited. Therefore, the results of this study are important for the rationale design of targeted NP imaging probes and therapeutics, including the translation of BP-PEG-Au NPs which enable improved sensitivity and specificity for the radiographic detection of abnormalities (e.g., µcals) in women with dense breast tissue. [ABSTRACT FROM AUTHOR]

Purpose A dual-energy material decomposition method using photon-counting spectral mammography was investigated as a non-invasive diagnostic approach to differentiate between Type I calcifications, consisting of calcium oxalate dihydrate or weddellite compounds that are more often associated with benign lesions, and Type II calcifications containing hydroxyapatite that are predominantly associated with malignant tumors. Methods The study was carried out by numerical simulation to assess the feasibility of the proposed approach. A pencil-beam geometry was modeled, and the total number of x-rays transported through a breast embedded with microcalcifications of different types and sizes were simulated by a one-pixel detector. Material decomposition using two energy bins was then applied to characterize the simulated calcifications into hydroxyapatite and weddellite using maximum-likelihood estimation, taking into account the polychromatic source, and the energy dependent attenuation. Simulation tests were carried out for different dose levels, energy windows and calcification sizes for multiple noise realizations. Results The results were analyzed using receiver operating characteristic ( ROC) analysis. Classification between Type I and Type II calcifications achieved by analyzing a single microcalcification showed moderate accuracy. However, simultaneously analyzing several calcifications within the cluster provided area under the ROC curve of greater than 99% for radiation dose greater than 4.8 mGy mean glandular dose. Conclusion Simulation results indicated that photon-counting spectral mammography with dual energy material decomposition has the potential to be used as a non-invasive method for discrimination between Type I and Type II microcalcifications that can potentially improve early breast cancer diagnosis and reduce the number of negative breast biopsies. Additional studies using breast specimens and clinical data should be performed to further explore the feasibility of this approach. [ABSTRACT FROM AUTHOR]

Purpose: Recent research suggests that image quality degradation with reduced radiation exposure in mammography can be mitigated by postprocessing mammograms with denoising algorithms based on convolutional neural networks. Breast microcalcifications, along with extended soft-tissue lesions, are the primary breast cancer biomarkers in a clinical x-ray examination, with the former being more sensitive to quantum noise. We test one such publicly available denoising method to observe if an improvement in detection of small microcalcifications can be achieved when deep learning-based denoising is applied to half-dose phantom scans., Approach: An existing denoiser model (that was previously trained on clinical data) was applied to mammograms of an anthropomorphic physical phantom with hydroxyapatite microcalcifications. In addition, another model trained and tested using all synthetic (Monte Carlo) data was applied to a similar digital compressed breast phantom. Human reader studies were conducted to assess and compare image quality in a set of binary signal detection 4-AFC experiments, with proportion of correct responses used as a performance metric., Results: In both physical phantom/clinical system and simulation studies, we saw no apparent improvement in small microcalcification signal detection in denoised half-dose mammograms. However, in a Monte Carlo study, we observed a noticeable jump in 4-AFC scores, when readers analyzed denoised half-dose images processed by the neural network trained on a dataset composed of 50% signal-present (SP) and 50% signal-absent regions of interest (ROIs)., Conclusions: Our findings conjecture that deep-learning denoising algorithms may benefit from enriching training datasets with SP ROIs, at least in cases with clusters of 5 to 10 microcalcifications, each of size ≲ 240    μ m ., (Published by SPIE.)

•The accuracy of ultrasound (US)-guided biopsies of suspicious microcalcifications without mass is similar, or even better than results published in literature with stereotactic-guided biopsies.•When the microcalcifications are visible on ultrasound, there is no loss of chance in performing the biopsy under ultrasound guidance rather than under stereotactic guidance.•US guidance allows access to difficult areas for stereotactic, increases the comfort of the patient, avoids compression and irradiation., Competing Interests: The authors declare that they have no conflicts of interest concerning this article., (© 2022 The Authors.)

Abstract: The purpose of this study is to evaluate breast microcalcifications according to morphology, distribution, level of suspicion, Breast Imaging Reporting and Data System (BI-RADS; fourth edition) final assessment, and recommendation categories and to assess positive predictive values and interobserver variability among three observers in 83 patients in whom biopsies had been performed. Although there is considerable inconsistencies in agreement between observers in the classification of microcalcifications, the usage of BI-RADS (fourth edition), in which the explicit recommendations for the description of the lesions was made, succeeds in the evaluation of microcalcifications. [Copyright &y& Elsevier]

Simple Summary: A diagnosis of ductal carcinoma in situ, made on biopsy, is often followed by surgery or radiotherapy because of the risk of an upgrading disease upon subsequent surgical specimens, finding invasive carcinoma. In order to select which patients can be spared overtreatments and alternatively followed with active surveillance, we retrospectively reviewed 2173 vacuum assisted breast biopsies. Our goal was to demonstrate if complete removal of the lesion by biopsy, documented by mammograms, can be a valid criterion to select the patients that can be spared further treatments. The results of our study demonstrate a significant lower upgrading rate of disease when the lesion is completely removed. Thus, performing a mammogram to document the absence of residual lesion following vacuum-assisted breast biopsy (VABB) allows us to reduce overtreatments and to select which patients can be followed with an active surveillance, sparing unjustified public health costs. Background: Considering highly selected patients with ductal carcinoma in situ (DCIS), active surveillance is a valid alternative to surgery. Our study aimed to show the reliability of post-biopsy complete lesion removal, documented by mammogram, as additional criterion to select these patients. Methods: A total of 2173 vacuum-assisted breast biopsies (VABBs) documented as DCIS were reviewed. Surgery was performed in all cases. We retrospectively collected the reports of post-VABB complete lesion removal and the histological results of the biopsy and surgery. We calculated the rate of upgrade of DCIS identified on VABB upon excision for patients with post-biopsy complete lesion removal and for those showing residual lesion. Results: We observed 2173 cases of DCIS: 408 classified as low-grade, 1262 as intermediate-grade, and 503 as high-grade. The overall upgrading rate to invasive carcinoma was 15.2% (330/2173). The upgrade rate was 8.2% in patients showing mammographically documented complete removal of the lesion and 19% in patients without complete removal. Conclusion: The absence of mammographically documented residual lesion following VABB was found to be associated with a lower upgrading rate of DCIS to invasive carcinoma on surgical excision and should be considered when deciding the proper management DCIS diagnosis. [ABSTRACT FROM AUTHOR]

The mammographic appearance of ductal carcinoma in situ (DCIS) is mostly observed as microcalcifications. Although stereotactic vacuum-assisted breast biopsy (VABB) is a reliable alternative to surgical biopsy for suspicious microcalcifications, underestimation of VABB-proven DCIS is inevitable in clinical practice. We therefore retrospectively analyzed the variables in the prediction of DCIS underestimation manifesting as microcalcifications only proved by stereotactic VABB. In 1147 consecutive VABB on microcalcification-only lesions from 2010 to 2016, patients diagnosed with DCIS were selected to evaluate the underestimation rate. The analyzed variables included clinical characteristics, mammographic features, VABB procedure, and biomarkers. Univariate and multivariate analyses were used, and a p value < 0.05 was considered statistically significant. Of the 131 VABB-proven DCIS, 108 cases were diagnosed with DCIS and 23 were upgraded to invasive ductal carcinoma (IDC) after subsequent surgery. The small extent of microcalcification, grouped microcalcifications distribution, nearly complete microcalcification removal, and non-calcified specimens without DCIS were low for DCIS underestimation. Among them, the results of non-calcified specimens with or without DICS were the only statistically significant variables by multivariate logistic regression. These results indicate that the histology of non-calcified specimens was highly predictive of DCIS underestimation. Specimens without DCIS had a low upgrade rate to IDC. [ABSTRACT FROM AUTHOR]

The potential of dual-energy mammography for microcalcification classification was investigated with simulation and phantom studies. Classification of type I/II calcifications was performed using the tissue attenuation ratio as a performance metric. The simulation and phantom studies were carried out using breast phantoms of 50% fibroglandular and 50% adipose tissue composition and thicknessess ranging from 3 to 6 cm. The phantoms included models of microcalcifications ranging in size between 200 and 900    μ m . The simulation study was carried out with fixed MGD of 1.5 mGy using various low- and high-kVp spectra, aluminum filtration thicknesses, and exposure distribution ratios to predict an optimized imaging protocol for the phantom study. Attenuation ratio values were calculated for microcalcification signals of different types at two different voltage settings. ROC analysis showed that classification performance as indicated by the area under the ROC curve was always greater than 0.95 for 1.5 mGy deposited mean glandular dose. This study provides encouraging first results in classifying malignant and benign microcalcifications based solely on dual-energy mammography images.

Breast density reduces the accuracy of mammography, motivating methods to improve sensitivity and specificity for detecting abnormalities within dense breast tissue, but preclinical animal models are lacking. Therefore, the objectives of this study were to investigate a murine model of radiographically dense mammary tissue and contrast-enhanced X-ray detection of microcalcifications in dense mammary tissue by targeted delivery of bisphosphonate-functionalized gold nanoparticles (BP-Au NPs). Mammary glands (MGs) in the mouse mammary tumor virus - polyomavirus middle T antigen (MMTV-PyMT or PyMT) model exhibited greater radiographic density with age and compared with strain- and age-matched wild-type (WT) controls at 6-10 weeks of age. The greater radiographic density of MGs in PyMT mice obscured radiographic detection of microcalcifications that were otherwise detectable in MGs of WT mice. However, BP-Au NPs provided enhanced contrast for the detection of microcalcifications in both radiographically dense (PyMT) and WT mammary tissues as measured by computed tomography after intramammary delivery. BP-Au NPs targeted microcalcifications to enhance X-ray contrast with surrounding mammary tissue, which resulted in improved sensitivity and specificity for detection in radiographically dense mammary tissues.

Background: An association between higher serum calcium (Ca 2+ ) levels and breast cancer has been previously reported. However, little is known regarding the relationship between serum Ca 2+ levels and the expression of Ca 2+ channels in the presence of breast microcalcifications., Methods: A retrospective analysis of women newly diagnosed with breast microcalcifications was performed based on the Breast Imaging Reporting and Data System (BI-RADS). The expression of TRPC1, TRPC3, and TRPM7 using normal biopsy without microcalcifications (controls) and infiltrating ductal carcinoma with microcalcifications was evaluated., Results: Data on 138 women were analyzed. Seventy percent of women had a BI-RADS score (1-3) corresponding to benign disease. Seventy-six percent of women with a BI-RADS score (4 or 5) were diagnosed with breast cancer, 56% were cancers in situ, and 93% were infiltrating ductal carcinomas. No difference in the distribution of corrected serum Ca 2+ levels between BI-RADS scores (1-3) and BI-RADS scores (4-5) ( P = 0.82) was observed. Serum Ca 2+ levels were similar in women without cancer and women diagnosed with breast cancer ( P = 0.94). However, the expression of TRPM7 and TRPC1, but not TRPC3, Ca 2+ channels were increased in infiltrating ductal carcinoma samples with microcalcifications when compared with age-matched controls without calcification or cancer., Conclusion: We observed an increase in the expression of TRPM7 and TRPC1 Ca 2+ channels in infiltrating ductal carcinoma samples with microcalcifications, whereas no change in serum Ca 2+ levels was observed. Together these data suggest that increased expression of these channels might lead to an increase in intracellular Ca 2+ levels thereby restoring serum Ca 2+ levels, but these can contribute to the breast microcalcifications. However, future studies exploring the intracellular Ca 2+ levels as well as the role of TRPM7 and TRPC1 function according to BI-RADS scores are needed.