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The aim of this study was to detect microcalcifications in human whole breast specimens using high-field MRI. Four mastectomy specimens, obtained with approval of the institutional review board, were subjected to gradient-echo MRI acquisitions on a high-field MR scanner. The phase derivative was used to detect microcalcifications. The echo time and imaging resolution were varied to study the sensitivity of the proposed method. Computed tomography images of the mastectomy specimens and prior acquired mammography images were used to validate the results. A template matching algorithm was designed to detect microcalcifications automatically. The three spatial derivatives of the signal phase surrounding a field-perturbing object allowed three-dimensional localization, as well as the discrimination of diamagnetic field-perturbing objects, such as calcifications, and paramagnetic field-perturbing structures, e.g. blood. A longer echo time enabled smaller disturbances to be detected, but also resulted in shading as a result of other field-disturbing materials. A higher imaging resolution increased the detection sensitivity. Microcalcifications in a linear branching configuration that spanned over 8 mm in length were detected. After manual correction, the automatic detection tool identified up to 18 microcalcifications within the samples, which was in close agreement with the number of microcalcifications found on previously acquired in vivo mammography images. Microcalcifications can be detected by MRI in human whole breast specimens by the application of phase derivative imaging.

Purpose To assess the occurrence and positive predictive value of additional nonmass findings to stratify the risk of breast microcalcifications. Methods This retrospective evaluation included 278 lesions with vacuum- or image-guided hook-wire biopsy for suspicious microcalcifications. The lesions were categorized into exclusive microcalcifications and microcalcifications with focal asymmetry, tubular density or architectural distortion (ie, nonmass findings). To evaluate the utility of additional nonmass findings for risk stratification, outcome variables were positive predictive values and odds ratios for malignancy and invasive carcinoma. Results Forty-five of 278 microcalcification lesions (16%) were associated with nonmass findings: 28 focal asymmetries, 2 tubular densities, and 15 focal asymmetries in conjunction with tubular densities. Architectural distortion was observed in 28 of these cases. The odds ratio for additional nonmass findings relative to exclusive microcalcifications was 5.9 and was statistically significant ( P < .00001). Architectural distortion was the most specific indicator for malignancy and invasiveness, with odds ratios of 6.5 ( P = .0072) and 5.6 ( P = .0214), respectively. Conclusions Microcalcifications with nonmass findings were less frequent than exclusive microcalcifications but were more predictive for malignancy. Architectural distortion demonstrated the highest risk of malignancy and invasiveness. Assessment of additional nonmass findings might be useful for further risk stratification of microcalcifications, indications for additional imaging, and pretreatment considerations.

This paper investigates whether photoacoustic imaging (PAI) can provide the visualization of microcalcifications in breast tissue. For this, the geometrical correlation between the 3-D PA images of breast microcalcifications within ex vivo specimens and the corresponding mammograms was ascertained. Also, the optical absorbance of the calcification compositions (i.e., hydroxyapatite and calcium oxalate) was measured and compared with the PA responses of the microcalcifications. The experimental results demonstrated that the PA images discriminated between the microcalcifications and the surrounding tissue, and their locations in PA images reasonably meshed with those of the microcalcifications appeared in the mammograms. Also, the change in PA signal amplitude along the laser wavelength agreed with the absorbance of hydroxyapatite associated with the relatively high potential of malignant cancers, but not calcium oxalate with only benign cases.

The twinkling artifact is well known as a color Doppler artifact but it is still an unresolved phenomenon [Rahmouni et al., Radiology 1996;199:269-271 ; Atan et al., Astas Urol Esp 2001;35:396-402; Kamaya et al., AJR 2003;80:215-222]. Many factors affect the appearance of the twinkling artifact, such as the surface roughness of stones creating multiple reflections and a form of intrinsic noise known as clock jitter within the Doppler circuitry of the ultrasound equipment. However, no studies have reported on the twinkling artifact of breast microcalcifications. While considering these premises, I detected microcalcifications in the breast using twinkling artifacts that could not be detected on B-mode imaging. The twinkling artifact is a well-defined but not well-understood phenomenon that may assist in the detection of calcified foci. The phenomenon of the twinkling artifact is discussed here with regard to prospectively and retrospectively studied cases including experiments with a new ultrasound modality called multidetector-ultrasonography (MD-US). MD-US using detectability of the twinkling artifact in microcalcifications of the breast may play an important role in breast screening.

Breast microcalcifications play an essential role in the detection and evaluation of early breast cancer in clinical diagnostics. However, in digital mammography, microcalcifications are merely graded with respect to their global appearance within the mammogram, while their interior microstructure remains spatially unresolved and therefore not considered in cancer risk stratification. In this article, we exploit the sub-pixel resolution sensitivity of X-ray dark-field contrast for clinical microcalcification assessment. We demonstrate that the micromorphology, rather than chemical composition of microcalcification clusters (as hypothesised by recent literature), determines their absorption and small-angle scattering characteristics. We show that a quantitative classification of the inherent microstructure as ultra-fine, fine, pleomorphic and coarse textured is possible. Insights underlying the micromorphological nature of breast calcifications are verified by comprehensive high-resolution micro-CT measurements. We test the determined microtexture of microcalcifications as an indicator for malignancy and demonstrate its potential to improve breast cancer diagnosis, by providing a non-invasive tool for sub-resolution microcalcification assessment. Our results indicate that dark-field imaging of microcalcifications may enhance the diagnostic validity of current microcalcification analysis and reduce the number of invasive procedures.

Rationale and Objectives This study evaluates the influence of the calibrated luminance level of medical displays in the detectability of microcalcifications and spiculated lesions in digital breast tomosynthesis images. Materials and Methods Four models of medical displays with calibrated maximum and minimum luminance, respectively, ranging from 500 to 1000 cd/m 2 and from 0.5 to 1.0 cd/m 2 , were investigated. Forty-eight studies were selected by a senior radiologist: 16 with microcalcifications, 16 with spiculated lesions, and 16 without lesions. All images were anonymized and blindly evaluated by one senior and two junior radiologists. For each study, lesion presence or absence and localization statements, interpretative difficulty level, and overall quality were reported. Cohen's kappa statistic was computed between monitors and within or between radiologists to estimate the reproducibility in correctly identifying lesions; for multireader-multicase analysis, the weighted jackknife alternative free-response receiver operating characteristic statistical tool was applied. Results Intraradiologist reproducibility ranged from 0.75 to 1.00. Interreader as well as reader-truth agreement values were >0.80 and higher with the two 1000 cd/m 2 luminance displays than with the lower luminance displays for each radiologist. Performances in the detectability of breast lesions were significantly greater with the 1000 cd/m 2 luminance displays when compared to the display with the lowest luminance value ( P value Conclusions Our findings highlight the role of display luminance level on the accuracy of detecting breast lesions.

In this paper we address the problem of differentiating between malignant and benign tumors based on their appearance in the CC and MLO mammography views. Classification of clustered breast microcalcifications into benign and malignant categories is an extremely challenging task for computerized algorithms and expert radiologists alike. We describe a deep-learning classification method that is based on two view-level decisions, implemented by two neural networks, followed by a single-neuron layer that combines the viewlevel decisions into a global decision that mimics the biopsy results. Our method is evaluated on a large multi-view dataset extracted from the standardized digital database for screening mammography (DDSM). Experimental results show that our network structure significantly improves on previously suggested methods.

Classification of clustered breast microcalcifications into benign and malignant categories is an extremely challenging task for computerized algorithms and expert radiologists alike. In this paper we present a novel method for feature selection based on mutual information (MI) criterion for automatic classification of microcalcifications. We explored the MI based feature selection for various texture features. The proposed method was evaluated on a standardized digital database for screening mammography (DDSM). Experimental results demonstrate the effectiveness and the advantage of using the MI-based feature selection to obtain the most relevant features for the task and thus to provide for improved performance as compared to using all features.

Dieses Heft von Ultraschall in der Medizin – European Journal of Ultrasound – (UiM-EJU) hat unter anderem 4 Arbeiten zum Thema Mammasonografie zum Inhalt 1 2 3 4. Neben der pränatalen Sonografie, die ein Schwerpunkt im Heft 03/2012 von UiM-EJU 5 6 7 8 9 10 ist, und neben der Kontrastmittelsonografie, der ein eigener Supplementband 2012 gewidmet ist 11 12 13 14 15 16 17 18, liegt die Mammasonografie unter den angenommenen Manuskripten in UiM unter den „Top 3“ der sonografischen Subspezialitäten. Grund genug daher, auch diesmal das breite Spektrum der technischen US-Applikationen und klinisch-sonografischen Aspekte der Mammasonografie in einem Editorial zu beleuchten 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58.Dabei sollen 2 Aspekte und Arbeiten besonders beachtet werden, welche die US-gezielte interventionelle Abklärung des Lymphknotenstatus bei Patientinnen mit Mammakarzinom 1 und die sonografische Detektion von Mikrokalk 2 zum Inhalt haben.I. Gruber et al. fassen in einem ausführlichen Review 1 den derzeitigen Stand der sonografischen Technik und klinischen Bedeutung der interventionellen Abklärung (gemeint ist die US-gezielte Gewebediagnose) sonografisch suspekter axillärer Lymphknoten zusammen. Dieses Thema war vor relativ kurzer Zeit auch Inhalt eines Editorials 41, wobei auf eine Arbeit zur dynamischen Kontrastmittelsonografie in der Unterscheidung benigner–maligner Lymphknoten bei Patientinnen mit Mammakarzinom Bezug genommen wurde 42. Denn, so eine der damaligen Schlussfolgerungen: „Finden wir nach sonografischen Kriterien suspekte axilläre Lymphknoten, dann sollten wir diesen Verdacht feingeweblich (bevorzugt Stanzbiopsie) abklären 41. Die Treffsicherheit der Biopsie ist hoch, die Komplikationsrate gering und der positive Nachweis von Lymphknotenmetastasen vermeidet die unnötige Durchführung einer Sentinellymphknoten-Entfernung (SLNE)“ 41. Die vorliegende Übersicht beleuchtet nun die relevante Literatur zur Gewebediagnose suspekter axillärer Lymphknoten 1 beim Mammakarzinom und schlägt einen Stufenplan zur prätherapeutischen Lymphknotenabklärung mittels sonografisch gesteuerter minimalinvasiver Interventionen vor. Dieser Algorithmus sieht zunächst die Anwendung einer Feinnadelaspiration (FNA, Nadeldurchmesser 20G) vor, bei inkonklusivem Ergebnis der FNA dann die Durchführung einer US-gezielten Stanzbiopsie, die bei gleich hoher Spezifität wie die FNA (beide Methoden 100 % oder nahe 100 %) eine etwas höhere Sensitivität aufweist. Die Autoren führen weiter korrekt aus, dass sowohl eine FNA als auch eine Stanzbiopsie mit für Malignität negativer Zytologie bzw. Histologie einen axillären Lymphknotenbefall keinesfalls „ausschließen“ kann. Daher ist der hohe positive Vorhersagewert beider Techniken relevant, der bei positivem Befund für Malignität die SLNE vermeidet. Bei für Malignität negativem Biopsieergebnis sollte die SLNE durchgeführt werden 1. Die in dieser Übersicht gemachte Unterscheidung FNA-Stanzbiopsie ist sicher diskussionswürdig, im klinischen Alltag wird aber sicher individuell (Größe des suspekten Lymphknotens, seine Beziehung zu Gefäßen, Erfahrung des Untersuchers, Verfügbarkeit zytologisch kompetenter Pathologen) zwischen FNA und Stanzbiopsie entschieden werden.Spannend ist die Originalarbeit von T. Fischer et al. 2, welche die sonografische Mikrokalkdetektion in der Mamma zum Inhalt hat. In einer In-vitro-Versuchsanordnung verglichen die Autoren die sonografische Detektion von Mikrokalk in 105 Mamma-Stanzzylindern (unter Verwendung von Frequenzcompounding, Tissue Harmonic Imaging und einer gerätespezifischen software [EMD – easy microcalcification detection, MicroPureTM, Toshiba, Otaware, Japan]) mit der Präparatradiografie und Histologie 2. Während im konventionellen B-Bild keine Darstellbarkeit der Mikroverkalkungen möglich war, konnte Mikrokalk mit EMB erkannt werden, der Mittelwert der Zahl der Verkalkungen im US war 3,5 ± 3,1, der in der Radiografie 4,3 ± 4,8; der Unterschied war nicht signifikant. Allerdings war die Mammografie dem US im Vergleich zum „Goldstandard“ Histologie in der Erkennung von Mikrokalk signifikant überlegen 2. Und subjektiv, schreiben die Autoren, waren besonders feingranuläre Kalkgruppen („cluster“) mit mehr als 14 Einzelverkalkungen mammografisch besser als sonografisch visualisierbar 2. Auch die Größenbestimmung der Verkalkungen war im US problematisch 2. Die Einstellungsstufe 1 (Farbe blau) der EMB-Software wurde gegenüber anderen Einstellungen am angenehmsten empfunden und zeigte geringere Artefakte 2.Ist es also an der Zeit, hochauflösenden US mit modernen US-Techniken zur Verbesserung der räumlichen Auflösung und dedizierter Software statt der Mammografie einzusetzen, um auch die etwa 40 % der nicht palpablen Karzinome mit US zu erfassen, bei denen Mikrokalk das alleinige oder weitgehende Malignitätskriterium ist? Nein, lautet die Antwort, und die Autoren der Studie 2 schreiben auch in der Einleitung sehr richtig, dass „die Mammografie der Goldstandard in der Detektion, Charakterisierung und Lokalisation von Mikrokalk bleibt“. Warum ist das so?Technische US-Weiterentwicklungen verbessern die Erkennbarkeit von Mikrokalk 2 32 34 52. Mikrokalk wird mammografisch nach BI-RADS 59 in „typisch gutartig“, „mittelgradig suspekt“ (amorphe oder unscharfe Verkalkungen) und „höhere Wahrscheinlichkeit für Malignität“ (pleomorphe oder heterogene Verkalkungen [granulär], feine, lineare oder feine, lineare, verästelte Verkalkungen) eingeteilt, wobei das Verteilungsmuster (gruppiert, linear, segmental, regional, diffus/verstreut) ein wichtiger Parameter der Charakterisierung ist. Die BI-RADS-analogen DEGUM-US-Kriterien aus 2006 58 unterscheiden Makrokalk (> 0,5 mm) von Mikrokalk, innerhalb und außerhalb einer Läsion. Das ACR-BI-RADS-US-Lexikon 60 differenziert zwischen Makrokalk und Mikrokalk, letzterem außerhalb und innerhalb eines Herdbefunds. Hier werden hyperechogene Punkte in einem echoarmen Herdbefund als „auffällig“ gewertet 60. Das heißt, die Morphologie der Mikroverkalkungen (und damit die Charakterisierung benigne–maligne) ist im US nicht möglich, was auch die vorgestellte Studie 2 an Mammastanzen zeigt. Es ist auch zu bedenken, dass nicht alle „echoreichen Punkte“ im Mamma-US Mikroverkalkungen sind, sondern dass Kollagenfasern und andere Veränderungen Mikrokalk vortäuschen können 37.Auch wenn in vitro Mikrokalk mit US erfasst werden kann, ist das Ergebnis nicht auf eine „Routine-US-Untersuchung“ der Mamma übertragbar. Manche Autoren meinen, dass insbesondere Kalk in echoarmen Läsionen und dilatierten Milchgängen gut erkannt wird 19 20 21 23 24 25 27 35, während isolierter Mikrokalk ohne umgebenden Herdbefund viel schlechter erfasst werden kann; dazu gibt es auch wenig Literatur. H. Madjar et al. 44 fanden in ihren 21 primär sonografisch entdeckten Karzinomen (von 86 Karzinomen gesamt) lediglich ein duktales Carcinoma in situ (DCIS), die übrigen Karzinome waren invasiv duktal (n = 16), invasiv lobulär (n = 3) und invasiv tubulär (n = 1), also Herdbefunde mit einem mittleren Durchmesser von 12,6 mm. Daher ist der US zum Screening von suspekten Mikroverkalkungen ungeeignet, da etwa 25 % aller im mammografischen Screening gefundenen Karzinome DCIS sind 28. US wird im österreichischen Screeningprogramm (die Einführung ist für 2013 geplant) auch nicht zur Mikrokalkdetektion, sondern zur Verbesserung der Detektion von Karzinomen bei mammografisch dichter Brust (ACR Grad 3 und 4) eingesetzt werden 26 61.Die meisten Studien zum Thema US und Mikrokalk untersuchten daher auch gezielt bereits mammografisch detektierte und bekannte Mikroverkalkungen 19 21 22 23 24 25 27 30 32 33 34 35 37 38, wobei übereinstimmend vor allem der Vorteil einer US-gezielten Stanz- oder Vakuum-Biopsie des Mikrokalks angeführt wird, wenn es gelingt, die mammografisch sichtbaren Mikroverkalkungen auch sonografisch zuzuordnen. Das Thema ist sicher weiter in Diskussion, und auch sehr schlechte Ergebnisse für die US-Detektion von mammografisch sichtbarem Mikrokalk wurden berichtet 38. Auf der anderen Seite des Spektrums steht eine rezente Publikation, die den sinnvollen Einsatz von US (zusammen mit der Mammografie) bei DCIS im Rahmen der brusterhaltenden Operation beschreibt 36.Der letzte Satz in der Arbeit von T. Fischer et al. lautet: „Die Mammografie bleibt der Goldstandard zur Detektion von Mikrokalk“ 2. Dieses Statement könnte bald durch die überlagerungsfreie digitale Tomosynthese der Brust falsifiziert werden. Wir sollten aber das Erscheinungsbild von Mikrokalk im US innerhalb und außerhalb von Herdbefunden kennen, um US vor allem in der US-geleiteten Gewebediagnose dieser Veränderungen schonend für die Patientinnen und ökonomisch einsetzen zu können.

OBJECTIVES The purpose of this study was to evaluate a new commercial image processing technique (MicroPure; Toshiba America Medical Systems, Tustin, CA) for identifying breast microcalcifications compared to gray scale ultrasound imaging (US) using mammography as the reference standard. METHODS Twenty women, with breast calcifications identified mammographically, underwent gray scale US and MicroPure examinations of the breast. Still images and digital clips of the target area were acquired using gray scale US and MicroPure (at 3 different sensitivity levels: 0, 1, and 2). The images were analyzed by 4 independent and blinded readers (2 radiologists and 2 physicists) to determine the number of calcifications as well as to score image quality and artifacts. RESULTS For all 4 readers, there were significantly more calcifications seen with MicroPure (at the 2 highest sensitivity levels) compared to gray scale US (P < .009). Agreement between readers consistently increased from gray scale US to MicroPure imaging (gray scale intraclass correlation coefficient, 0.02-0.44; versus MicroPure intraclass correlation coefficient, 0.34-0.71). The agreement improved between mammography and MicroPure (13.2%-28.3%) when compared with mammography and gray scale US (1.7%-5.2%); the 2 radiologists saw a bigger improvement. Two readers preferred the MicroPure image quality over gray scale US (P < .001) and vice versa for the other 2 readers(P < .001). All 4 readers saw fewer artifacts with MicroPure (at level 2) than with gray scale US (P < .02). CONCLUSIONS MicroPure imaging identified significantly more breast microcalcifications than gray scale US.

The specimens obtained through excisional biopsy (EB) are commonly large in size and it is difficult to remove the tissues containing nonpalpable calcifications accurately from them for pathologic examination. Therefore, the aim of the study is to develop a novel method of subarea localization technique (SLT) for sampling from the postexcisional specimens. A retrospective clinical study of 48 consecutive patients with breast microcalcifications were divided into a study group (n = 24 patients, 25 breasts) and a control group (n = 24 patients, 24 breasts) in time sequence. The specimens of study group were localized by SLT performed by cutting lines and/or metallic markers. The main study end points were the duration of intraoperative pathologic diagnosis (DIPD) and duration of conclusive pathology diagnosis (DCPD). The number of frozen blocks, number of paraffin blocks, number of sections, and other parameters correlated with pathologic diagnosis were compared between the two groups. SLT was succeeded in 48 of 48 (100%) patients, which shortened DIPD (29.3 vs 45.5 minutes, P < 0.01) significantly with less frozen blocks (6.2 vs 12.6, P < 0.01) and less frozen sections (8.5 vs 13.7, P = 0.01) than that of the control group. Moreover, SLT shortened DCPD (4.1 vs 5.1 days, P = 0.02) with less paraffin blocks (12.2 vs 21.7, P < 0.01) and less paraffin sections (20.0 vs 39.9, P < 0.01) than that of the control group. SLT decreased workload of the specimens sampling procedure and SLT may be recommended as a reliable specimens sampling method to guide pathology test for EB specimens containing calcifications.

Background Morphology microcalcification descriptors help stratify the risk of breast malignancy. Micro CT is feasible for visualization of the fine-structure of tissues and may be suitible for high resolution microcalcification analysis. Purpose To analyze the interior structure of microcalcifications using a micro CT imaging system. Material and Methods Core needle breast biopsy specimens from 16 women with clustered microcalcifications were examined with micro CT. The samples measured between 0.8 to 1.2 mm in diameter. Micro CT scans with an isotropic voxel size of 8.4 µm were obtained to generate two- and three-dimensional images of the microcalcifications. The number of microcalcifications were counted on the magnified specimen radiogram and on micro CT. Attenuation values of microcalcifications were measured by drawing a region of interest (ROI) in the center of the microcalcifications. Two blinded observers assessed the morphology and the interior structure of microcalcifications. Results Five patients had benign and 11 patients had malignant breast lesions. On micro CT, microcalcifications of benign tissue showed a coarse lamellar or trabecular interior structure, whereas microcalcifications of breast cancer tissue showed a more uniform granular interior structure. There was no correlation between attenuation values of benign compared with malignant microcalcifications. Conclusion On micro CT, an interior structure of microcalcifications is detectable. Benign and malignant microcalcifications display different patterns of interior structure.

Background Management of suspicious microcalcifications in very thin breasts is problematic. Purpose To evaluate whether sonographically-guided vacuum-assisted biopsy (USVAB) with digital mammography-guided skin marking (DM) for the diagnosis of breast microcalcifications is comparable to stereotactic-guided vacuum-assisted biopsy (SVAB) in Asian women with thin breasts. Material and Methods Retrospective review was performed for 263 consecutive suspicious microcalcification lesions in 261 women who underwent USVAB with DM or SVAB using a prone table between January 2004 and December 2007. SVAB was performed for 190 lesions and USVAB for 73 lesions. Biopsy results were correlated with surgical pathology or followed up for at least 12 months. The diagnostic outcomes of SVAB and USVAB to diagnose microcalcifications were compared. Results Of 263 lesions, 104 (40%) underwent surgery and 159 (60%) were followed up. SVAB and USVAB groups showed similar final categories or the extent of microcalcifications. US visible lesions were 57 (78%) of 73 at USVAB and 14 (10%) of 140 at SVAB. Of 57 US visible lesions at USVAB, 29 (51%) were not found in initial US but were detectable with the help of DM. Specimen radiographs were negative in 2.1% of lesions at SVAB and in 4.1% at USVAB ( p = 0.4008). The under-estimation rate and false-negative rate were similar in SVAB and USVAB. Conclusion US with DM facilitates US visibility of microcalcifications. USVAB with DM can produce acceptable biopsy results, as can SVAB, to diagnose breast microcalcifications in patients with thin breasts.

Background: Early diagnosis and treatment is essential for curing breast tumors. In recent years, the number of diagnosed nonpalpable breast lesions has risen rapidly following increased breast cancer awareness and the broad promotion of mammography (MMG) screening. Aim: A comparison of the effect and accuracy between the superficial mark guided localization technique (SGL) and the hook wire guided localization technique (WGL) for nonpalpable breast microcalcifications. Methods: Retrospective research was conducted to compare SGL and WGL techniques. These techniques were performed on 51 patients with nonpalpable breast microcalcifications from the months of Jan 2015 to May 2016. Results: A total of 51 patients with ages ranging from 32 to 72 years were included in the study; 25 (49.01%) patients were randomly selected for the WGL group, while the other 26 (50.99%) patients were randomly selected for the SGL group. One case in the WGL group was treated with the SGL technology due to technical difficulties with the localization procedure. No statistically significant association was found between the 2 groups within the specified diameter of excised tissue. For the WGL group and SGL group, the average diameter of excised tissue was 78.4 mm and 78.9 mm, respectively. No complications were observed for patients in the SGL group, whereas 4 patients in the WGL group experienced complications. Two patients had a vasovagal reaction and another 2 experienced ecchymoma or shifting of the hook wire. According to the paraffin result, we found 3 (12%) malignant cases in the WGL group and 6 (23%) malignant cases in the SGL group. Conclusion: The superficial mark localization technique is as accurate as the hook wire guided localization technique. The procedure has the advantages of being less expensive and causes less complications.

Screening mammography is one of the most challenging radiological techniques and this is partly due to the difficulty in detecting microcalcifications (MCs) against an anatomical background of varying mammographic tissue density. Further complicating factors in the detection of MCs include the small size and their resemblance to other bright structures in the breast. A number of different microcalcification simulating materials are available and these are often incorporated in test objects used to study some aspects of an imaging system, for example, optimal beam quality selection in digital mammography. Aluminum (Al) has similar x-ray attenuation properties to MCs and therefore Al is extensively used in test objects. However, to the best of our knowledge, the suitability of Al as a substitute material for MCs has not been studied explicitly. The aim of this study was therefore to demonstrate that spectral optimization studies for MCs can be performed with Al sheets. The approach used was twofold. First, contrasts generated by Al and MCs at several exposure settings were compared, and secondly an optimization study was performed with both Al and MCs as the contrasting target using an amorphous selenium (a-Se) based digital mammography unit. Specimens from stereotactic vacuum-assisted breast biopsies of non-palpable lesions with mammographic evidence of MCs were obtained from clinical routine patients. Contrasts generated by these MCs and by Al sheets were measured for Mo/Mo, Mo/Rh and W/Rh anode/filter combinations, for different polymethylmethacrylate (PMMA) thicknesses at the extremes of the x-ray tube voltages used clinically. A linear regression was then applied between the two measurements of contrast; the ratio of the angular coefficient q obtained from the fitted regression lines for Al and MCs ranged from 0.96 to 0.99 for Mo/Mo and Mo/Rh combinations at 2 and 4 cm PMMA, respectively, and from 0.83 at 4 cm PMMA to 1.14 at 7 cm PMMA for the W/Rh combination. For the optimization study, the signal-difference-to-noise ratio (SDNR) measured using the MCs was plotted as a function of mean glandular dose (MGD) for 4 cm PMMA, for the three different anode/filter combinations. The W/Rh combination always gave the highest SDNR for a given MGD. The SDNR and MGD were then used to define the common figure of merit SNR(2)/MGD; the setting that maximized this measure at 4 cm PMMA was 27 kV and a W/Rh combination. These results demonstrate a close correspondence between the attenuation properties of Al and extracted MC material over the energy range studied for the Mo/Mo, Mo/Rh and W/Rh anode/filter combinations. Furthermore, it was found that the exposure parameters that maximized the figure of merit for the MC specimen agree with results found in studies that used Al sheets as a substitute for the MC.

Objective The aim of this study was to evaluate the utility of an upright-type 11-gauge stereotactic vacuum-assisted biopsy device (Mammotome®) for the diagnosis of breast microcalcifications

Aims To evaluate the surgical management of patients who underwent VLNB for breast microcalcifications. Methods This retrospective study compared the histological results and the surgical procedures in two groups of patients, group 1: large-core needle biopsy n = 1009, and group 2: surgical biopsy n = 270. Results After VLNB, 54% patients were not operated on after stereotactic large-core needle biopsy, 42% underwent one operation, 4% underwent two operations and 0.2% underwent three operations. No surgery was performed for 95% of benign lesions. Multiples operations were necessary in 12% of patients with malignant lesions of VLNB group compared to 45% in the surgical biopsy group. The rate of underdiagnosis of borderline lesions and ductal carcinomas in situ was 16% by the large-core biopsy technique. Conclusion VLNB constitutes an alternative to surgical biopsy. This procedure avoids surgery for most benign lesions and reduces the number of surgical procedures in malignant lesions.

One of your patients, a 57-year-old woman, presents to the primary care setting, clutching the results of her routine mammography screening test. She says she was told that her mammogram shows microcalcifications and that she needs further testing. She's fearful, asking you, "Does this mean I have cancer?" How do you help her interpret her mammogram results and give her guidance? A thorough understanding of the significance of pathophysiologic positive findings on routine mammograms in asymptomatic women will inform your choice of anticipatory guidance and continued care.

Breast cancer is one of the most deadly cancers in the world, especially among women. With no identified causes and absence of effective treatment, early detection remains necessary to limit the damages and provide possible cure. Submitting women with family antecedent to mammography periodically can provide an early diagnosis of breast tumors. Computer Aided Diagnosis (CAD) is a powerful tool that can help radiologists improving their diagnostic accuracy at earlier stages. Several works have been developed in order to analyze digital mammographies, detect possible lesions (especially masses and microcalcifications) and evaluate their malignancy. In this paper a new approach of breast microcalcifications diagnosis on digital mammograms is introduced. The proposed approach begins with a preprocessing procedure aiming artifacts and pectoral muscle removal based on morphologic operators and contrast enhancement based on galactophorous tree interpolation. The second step of the proposed CAD system consists on segmenting microcalcifications clusters, using Generalized Gaussian Density (GGD) estimation and a Bayesian back-propagation neural network. The last step is microcalcifications characterization using morphologic features which are used to feed a neuro-fuzzy system to classify the detected breast microcalcifications into benign and malignant classes.

In this chapter, a dose-compatible diagnostic tool for the assessment and risk stratification of breast microcalcifications exploiting the sub-pixel resolution sensitivity of X-ray dark-field is presented. First, the diagnostic importance of breast microcalcification grading and its clinical limitations are illustrated, by which the necessity and potential of additional, refining classification procedures is given credit. Our results indicate that dark-field imaging of microcalcifications may enhance the diagnostic validity of current microcalcification analysis and reduce the number of invasive procedures. Finally, we take a critical look at a recent publication, which suggest a chemically-based assessment of calcifications by means of dark-field mammography. Note that this chapter has been submitted for publication to Scientific Reports as “Scherer, K. et al. Improved mammography diagnostics by assessing the micromorphology of breast calcifications via X-Ray dark-field radiography”.

Classification of clustered breast microcalcifications into benign and malignant categories is an extremely challenging task for computerized algorithms and expert radiologists alike. In this paper we apply a multi-view-classifier for the task. We describe a two-step classification method that is based on a view-level decision, implemented by a logistic regression classifier, followed by a stochastic combination of the two view-level indications into a single benign or malignant decision. The proposed method was evaluated on a large number of cases from a standardized digital database for screening mammography (DDSM). Experimental results demonstrate the advantage of the proposed multi-view classification algorithm that automatically learns the best way to combine the views.

Early detection is key to surviving breast cancer. The earliest indication of potential breast cancer detectable by current screening methods is the presence of microcalcifications. The low efficiency of ultrasound in detecting these microcalcifications is due to several factors, including the low spatial resolution of the ultrasound images and the speckle noise, which masks the tiny microcalcifications. This paper aims to investigate the efficiency of the time reversal multiple signal classification algorithm in detecting breast microcalcifications. Experiments were performed on numerical phantoms, and results show that the TR-MUSIC algorithm efficiency depends on several parameters.

Microcalcifications are an early mammographic sign of breast cancer and frequent target for stereotactic biopsy. Despite their indisputable value, microcalcifications, particularly of the type II variety that are comprised of calcium hydroxyapatite deposits, remain one of the least understood disease markers. Here we employed Raman spectroscopy to elucidate the relationship between pathogenicity of breast lesions in fresh biopsy cores and composition of type II microcalcifications. Using a chemometric model of chemical-morphological constituents, acquired Raman spectra were translated to characterize chemical makeup of the lesions. We find that increase in carbonate intercalation in the hydroxyapatite lattice can be reliably employed to differentiate benign from malignant lesions, with algorithms based only on carbonate and cytoplasmic protein content exhibiting excellent negative predictive value (93–98%). Our findings highlight the importance of calcium carbonate, an underrated constituent of microcalcifications, as a spectroscopic marker in breast pathology evaluation and pave the way for improved biopsy guidance., National Institute for Biomedical Imaging and Bioengineering (U.S.) (9P41EB015871-27A1), Johns Hopkins University. Whiting School of Engineering, National Cancer Institute (U.S.) (R01-CA140288)

Breast microcalcifications are routinely explored for mammographic detection of breast cancer and are primarily composed of non-stoichiometric hydroxyapatite (Ca10−x(PO4)6−x(CO3)x(OH)2−x) (HA). Interestingly, HA morphology and carbonate substitution vary in malignant vs. benign lesions. However, whether or not these changes (i) are functionally linked and (ii) impact malignancy remains unclear due in part to lack of model systems that permit evaluating these possibilities. Here, we have adapted a 96 well-based mineralized culture platform to investigate breast cancer cell behavior in response to systematic changes in the chemical and physical properties of HA. By adjusting the carbonate content of the simulated body fluid (SBF) solutions used during growth, we can control the morphology and carbonate substitution of the deposited HA. Our results suggest that both the combined and individual effects of these differences alter breast cancer cell growth and secretion of tumorigenic interleukin-8 (IL-8). Consequently, changes in both HA carbonate incorporation and morphology impact the behavior of breast cancer cells. Collectively, our data underline the importance of biomineralized culture platforms to evaluate the functional contribution of HA material properties to the pathogenesis of breast cancer. Statement of Significance Breast microcalcifications are small mineral deposits primarily composed of hydroxyapatite (HA). HA physicochemical properties have been of considerable interest, as these are often altered during breast cancer progression and linked to malignancy. However, the functional relationship between these changes and malignancy remains unclear due in part to lack of model systems. Here, we have adapted a previously developed a 96 well-based culture platform to evaluate breast cancer cell behavior in response to systematic changes in HA properties. Our results demonstrate that changes in HA morphology and carbonate content influence breast cancer cell growth and interleukin-8 secretion, and suggest that characterizing the effect of HA properties on breast cancer cells may improve our understanding of breast cancer development and progression.

Summary Mammographic detection and characterization of breast microcalcifications is important in the early diagnosis of ductal carcinoma in situ. A case is presented where tungsten microparticles simulated microcalcifications and prompted a full diagnostic assessment. The likely origin of the particles is discussed and the published work on metallic particles in the breast is reviewed. Awareness of possible alternative causes for apparent microcalcifications at mammography is important for the breast radiologist and pathologist.

Purpose: To classify mammary microcalcifications for the prediction of malignancy by using computer-aided analysis of morphometric characteristics. Materials and Methods: Seven-fold microfocus magnification radiography (direct magnification) was performed on 2975 paraffin embedded microcalcifications. After digitization of the radiographic films and segmentation of the microcalcifications, the morphometric characteristics, such as circumference, surface and polar transformation with determination of the greatest and smallest radius, were measured. Using the classification and regression tree (CART) statistical analysis program, the calcifications were classified by computer on the basis of the morphometric characteristics and the known histological result. Results: Benign conditions were essentially represented by small round calcifications with a greatest radius of 18.5 μm and a circumference of ≤ 462.3 μm. Using > 70% microcalcifications classified in a patient by the computer as "malignant," CART increases the frequency of malignant conditions, with the diagnostic separation between benign and malignant at an Az value (surface below the ROC curve) of 0.7863. Conclusion: A computer-assisted classification of individual microcalcifications on the basis of morphometric characteristics can supplement the information for a computer assisted mammographic diagnosis (CAD).

Computer-aided diagnostic (CAD) schemes have been developed to assist radiologists in the detection of various abnormalities in medical images such as lung nodules, intracranial aneurysms, and breast microcalcifications. In order to improve the sensitivity for detection of abnormalities, many researchers have employed filters for enhancement of a specific type of abnormality. However, these filters generally enhance not only the specific type of lesion, but also normal anatomic structures such as ribs, blood vessels, and airway walls. Therefore, lesions are often detected together with a large number of false positives caused by the normal anatomic structures. In this study, we developed selective enhancement filters for lung nodules, intracranial aneurysms, and breast microcalcifications, which can simultaneously enhance a specific type of lesion and suppress normal anatomic structures such as blood vessels and airway walls. Therefore, as preprocessing steps, these filters would be useful for improving the sensitivity of lesion detection and for reducing the number of false positives. We applied the selective enhancement filters to two-dimensional mammography, three-dimensional computed-tomography images, and magnetic resonance angiography (MRA) images to show its effectiveness for the enhancement of lung nodules, intracranial aneurysms, and breast microcalcifications.

The purpose of this study was to evaluate the ability of sonography to depict and guide biopsies of mammographically suspicious microcalcifications and to reveal the mammographic features and histologic outcomes of lesions amenable to sonographically guided biopsy.. Suspicious clusters of microcalcifications without other mammographic abnormalities were evaluated on sonography before biopsy and divided into two groups: those with and those without microcalcifications seen on sonography. Sonographically detected lesions underwent sonographically guided biopsy; lesions not seen on sonography underwent mammographically guided biopsy. Imaging features and histologies were correlated, and the positive predictive value of sonography was determined.Of 111 lesions (105 patients), 26 lesions (23%) were identified and underwent sonographically guided biopsy; 85 lesions (77%) were not identified sonographically. The diameters of microcalcification clusters in the sonographically identified group were significantly larger (p = 0.0005) and contained larger numbers of microcalcification particles (p = 0.038) compared with clusters not identified sonographically. Sonographically identified lesions were seen as masses (77%) or dilated ducts (23%) with echogenic foci. Sonographically identified lesions were more likely to be malignant than those not seen on sonography (69% vs 21%, respectively; p0.00002). Of 38 malignant lesions, those visible on sonography were more likely to be invasive than those not seen on sonography (72% vs 28%, respectively; p = 0.018). In malignant lesions undergoing core biopsy and surgical excision, the extent of disease was underestimated less with sonographically guided biopsy (7%, 1/15) than with stereotactic biopsy (33%, 5/15).Suspicious microcalcifications are seen infrequently on sonography (23%) but, when detected, can be successfully biopsied with sonographic guidance and more frequently are malignant and represent invasive cancer than those seen on mammography alone.

In 824 patients who underwent directional vacuum-assisted biopsies (DVABs) of breast microcalcifications, 61 (7.4%) showed atypical ductal hyperplasia (ADH). The 42 who subsequently underwent excision were the subjects of this study. Cases were evaluated for the mammographic characteristics of the lesion, the percentage of lesion removed according to mammography, and histologic findings (including number of large ducts and/or terminal duct–lobular units involved with ADH) in DVAB specimens. Pathologic findings in the surgical specimens in the area of the biopsy site also were recorded. In the DVAB specimens, ADH was confined to an average of 1.5 large ducts or lobular units and was associated with microcalcifications in all of the patients. Surgical specimens showed ADH in 15 cases, no residual lesion in 24 cases, and ductal carcinoma in situ in 3 cases. We found that microcalcifications that contain ADH in less than 3 lobules or ducts and/or that are removed completely by DVAB do not reveal higher-risk lesions on excision; thus, removal is unnecessary. When assessing microcalcifications with ADH, clinicians should consider the percentage of microcalcifications removed by DVAB and the extent of lobular involvement to better assess the need for excision.

Common conflict in surgery: How to evaluate breast microcalcifications? Objective: Breast cancer is still one of the leading causes of death among women. Microcalcifications are important cues for the early diagnosis of breast cancer. Materials and Methods: Data from a total of 74 patients, who had microcalcifications in mamography and undergone wire-guided excision, was evaluated prospectively. Results: Pathologic examination showed 35% of patients (n=26) had ductal carcinoma in situ and / or invasive ductal carcinoma. 60% (n=6) of 10 lesions that were considered as benign preoperatively, diagnosed as benign in pathological evaluation whereas 65.6% (n=42) of 64 lesions that were considered as suspicious preoperatively diagnosed as benign by pathological avaluation. Conclusion: All microcalcifications in the breast should be evaluated by excisional biopsy beyond the core biopsy

This paper presents a novel classification approach for microcalcifications extracted from core biopsy tissue samples digitized using micro-CT, a high-resolution 3D imaging modality. Microcalcifications are tiny spots of calcium that may occur in the female breast. Although they are common in healthy woman, they are often an early sign of breast cancer. In case of suspiciousness, a biopsy is conducted and the extracted tissue is pathologically analyzed for the presence of cancer cells. The calcifications themselves however are mostly not analyzed. As a result, there is a ground truth for the tissue samples but not for the individual calcifications. Therefore, this paper presents an approach where the calcifications are first classified according to shape-based clusters before predicting a label for the tissue samples.

Microcalcifications are localized deposits of calcium in breast tissues within the most clinically significant abnormality of the gland and are considered an early mammographic evidence of breast cancer. Increasing evidences suggest that the morphological appearance and the molecular structures of microcalcifications could be related to patient’s prognosis.

The usefulness of breast ultrasound could be extended by improving the detection of microcalcifications by being able to detect and enhance microcalcifications while simultaneously eliminating hyperechoic spots (e.g., speckle noise and fibrocystic changes) that can be mistaken for microcalcifications (i.e., false microcalcifications). This study investigated the use of a strain-compounding technique with speckle factor (SF) imaging to analyze the degree of scatterer redistributions in breast tissues under strain conditions for identifying microcalcifications and false microcalcifications. The efficacy of the proposed method was tested by collecting raw data of ultrasound backscattered signals from 26 lesions at BI-RADS category 4 or 5 with suspicious microcalcifications. The different strain conditions were created by applying manual compression to deform the breast lesion. For each region in which microcalcifications were suspected, estimates of the SNR of the strain-compounding B-scan images and estimates of the mean SF (SFavg) in the strain-compounding SF images were calculated. Compared with microcalcifications, the severity of speckle of the false microcalcifications would be easily degraded under compressive strain conditions. The results demonstrated that the SNR estimates in the strain-compounding B-scan images for microcalcifications and false microcalcifications were 5.22 ± 1.04 (mean ± standard deviation) and 4.62 ± 1.09, respectively; the corresponding SFavg estimates in the strain-compounding SF images were 0.47 ± 0.10 and 0.22 ± 0.10 (p < 0.01). The mean area under the receiver operating characteristic curve using the SNR estimate was 0.71, whereas that using the SFavg estimate was 0.94. These findings indicate that the strain-compounding SF imaging method is more effective at discriminating between microcalcifications and false microcalcifications.

Background There is a lack of data concerning diagnostic performance of magnetic resonance imaging (MRI) in patients with new or increasing microcalcifications. Purpose To evaluate suspicious microcalcifications by using comparison mammography, MRI, and a combination of both methods. Material and Methods Our study group consisted of 55 patients with mammographically detected BI-RADS (Breast Imaging Reporting and Data System) 3–5 microcalcifications for whom comparison mammograms were available. All patients underwent breast MRI before SVAB (stereotactic vacuum-assisted biopsy). Diagnostic performances of comparison mammography and MRI were evaluated, as well as the combination of the respective imaging findings. Results Of the 55 microcalcification cases, 35 showed progression and 20 were stable between interval screenings. The negative predictive value (NPV) of comparison mammography was 100%, whereas the NPV of MRI was 92%. However, the specificity of combination of findings was 97%, significantly higher than the 42% specificity of comparison mammography ( P Conclusion A biopsy is recommended when MRI positive lesion corresponding the area of new or increasing mammographic microcalcifications is detected. Patients with stable microcalcifications can continue follow-up mammography, regardless of MRI result.

The capability of the mammography-scintimammography combination to distinguish between benign and malignant isolated clusters of breast microcalcifications is discussed. Scintimammography using Tc 99m-Sestamibi was performed in 97 women with an isolated cluster of microcalcifications on mammograms. Seventy-two women had final histopathologic diagnoses (24 cancer and 48 benign pathology). The other 25 patients had follow-up to 3 years. The results of mammography, scintimammography and mammography-scintimammography combination were divided into five groups, based on the suspicion of malignancy. The sensitivity, specificity, false negative fraction, false positive fraction, predictive positive value, predictive negative value and diagnostic accuracy were calculated varying the diagnostic threshold. The Receiver Operating Characteristic (ROC) statistical technique was employed to compare the diagnostic value of mammography to mammography-scintimammography combination. The area under the ROC curves was calculated by the Wilcoxon statistic without any hypothesis on data distribution. The detected difference between areas under the mammography ROC curve (area=0.854, standard error=0.049) and mammography-scintimammography ROC curve (area=0.897, standard error 0.033) was statistically significant (P>0.05, one tail). The area under a ROC curve represents the probability that a randomly chosen diseased or non-diseased subject could be correctly classified. From this point of view this paper demonstrates that, if properly used, scintimammography can add to mammography in the characterization of an isolated cluster of microcalcifications, even if it is not able to replace FNAB and core biopsy.

To determine whether ultrasonography (US) can depict breast masses associated with mammographically detected clustered microcalcifications and whether the visibility at US is different between benign and malignant lesions.Ninety-four patients with 100 mammographically detected microcalcification clusters prospectively underwent US with a 10- or 12-MHz transducer before mammographically guided presurgical hook-wire localization. The visibility of breast masses at US was correlated with histologic and mammographic findings.Surgical biopsy revealed 62 benign lesions, 30 intraductal cancers, and eight invasive cancers. At US, breast masses associated with microcalcifications were seen in 45 (45%) of 100 cases. US depicted more breast masses associated with malignant (31 [82%] of 38) than with benign (14 [23%] of 62) microcalcifications (P:.001). In malignant microcalcification clusters larger than 10 mm, US depicted associated breast masses in all 25 cases. There was no statistically significant difference in shape and distribution of calcific particles, as well as in breast composition, at mammography between US visible and invisible groups.Given a known mammographic location, US with a high-frequency transducer can depict breast masses associated with malignant microcalcifications, particularly clusters larger than 10 mm. US can be used to visualize large clusters of microcalcifications that have a very high suspicion of malignancy.

AIM: To verify the diagnostic value of the traditional definition of ‘clustering’ of microcalcifications (more than five in the area of 1 cm 2 or 1 cm 3 ) on mammography in the differential diagnosis of benign and malignant breast disease. METHODS AND MATERIALS: Three radiologists without knowledge of the final pathology retrospectively counted the number of microcalcifications per 0.25 cm 2 (0.5 × 0.5 cm) unit area on mammography in 57 pathologically proven non-palpable lesions including 26 cancers and 31 benign diseases. Pleomorphism of the microcalcifications, associated architectural distortion or mass or increased density and distribution of microcalcifications were also evaluated. RESULTS: The mean numbers of microcalcifications per 0.25 cm 2 were 16.4 in malignant and 16.7 in benign diseases (no statistically significant difference between the two groups). Pleomorphism of the microcalcifications, associated architectural distortion or mass or increased density were, however, important determining parameters. Clustering was more frequently observed in benign diseases. CONCLUSION: In this study, the mean number of microcalcifications per unit area is much larger than the traditional definition of ‘clustering’ and clustering itself is not effective in the differential diagnosis of benign and malignant breast lesions. Imaging features other than numbers of calcification per unit area are more important in assessing the significance of mammographic clustered microcalcifications.Park, J. M. (2000). Clinical Radiology 55 , 114–118.

BackgroundWe presented the photoacoustic imaging (PAI) tool and to evaluate whether microcalcifications in breast tissue can be detected on photoacoustic (PA) images.MethodsWe collected 21 cores containing microcalcifications (n = 11, microcalcification group) and none (n = 10, control group) in stereotactic or ultrasound (US) guided 8-gauge vacuum-assisted biopsies. Photoacoustic (PA) images were acquired through ex vivo experiments by transmitting laser pulses with two different wavelengths (700 nm and 800 nm). The presence of microcalcifications in PA images were blindly assessed by two radiologists and compared with specimen mammography. A ratio of the signal amplitude occurring at 700 nm to that occurring at 800 nm was calculated for each PA focus and was called the PAI ratio.ResultsBased on the change of PA signal amplitude between 700 nm and 800 nm, 10 out of 11 specimens containing microcalcifications and 8 out of 10 specimens without calcifications were correctly identified on blind review; the sensitivity, specificity, accuracy, positive predictive and negative predictive values of our blind review were 90.91%, 80.0%, 85.71%, 83.33% and 88.89%. The PAI ratio in the microcalcification group was significantly higher than that in the control group (the median PAI ratio, 2.46 versus 1.11, respectively, P = .001). On subgroup analysis in the microcalcification group, neither malignant diagnosis nor the number or size of calcification-foci was proven to contribute to PAI ratios.ConclusionBreast microcalcifications generated distinguishable PA signals unlike breast tissue without calcifications. So, PAI, a non-ionizing and non-invasive hybrid imaging technique, can be an alternative in overcoming the limitations of conventional US imaging.

Microcalcifications are small crystals of calcium apatites which form in human tissue through a number of mechanisms. The size, morphology, and distribution of microcalcifications are important indicators in the mammographic screening for and diagnosis of various carcinomas in the breast. Although x-ray mammography is currently the only accepted method for detecting microcalcifications, its efficacy in this regard can be reduced in the presence of dense parenchyma. Current ultrasound scanners do not reliably detect microcalcifications in the size range of clinical interest. The results of theoretical, simulation, and experimental studies focused on the improvement of the ultrasonic visualization of microcalcifications are presented. Methods for estimating the changes in microcalcification detection performance which result from changes in aperture geometry or the presence of an aberrator are presented. An analysis of the relative efficacy of spatial compounding and synthetic receive aperture geometries in the detection of microcalcifications is described. The impact of log compression of the detected image on visualization is discussed. Registered high resolution ultrasound and digital spot mammography images of microcalcifications in excised breast carcinoma tissue and results from the imaging of suspected microcalcifications in vivo are presented.

Objectives: To compare the visualization and image quality of microcalcifications imaged with digital breast tomosynthesis (DBT) versus conventional digital mammography. Materials and Methods: Patients with microcalcifications detected on full field digital mammography (FFDM) recommended for needle core biopsy were enrolled in the study after obtaining patient's consent and institutional review board approval (n = 177 patients, 179 lesions). All had a bilateral combination DBT exam, after undergoing routine digital mammography, prior to biopsy. The study radiologist reviewed the FFDM and DBT images in a non-blinded comparison and assessed the visibility of the microcalcifications with both methods, including image quality and clarity with which the calcifications were seen. Data recorded included patient demographics, lesion size on FFDM, DBT, and surgical excision (when applicable), biopsy, and surgical pathology, if any. Results: Average lesion size on DBT was 1.5 cm; average lesion size on FFDM was 1.4 cm. The image quality of DBT was assessed as equivalent or superior in 92.2% of cases. In 7.8% of the cases, the FFDM image quality was assessed as equivalent or superior. Conclusion: In our review, DBT image quality appears to be comparable to or better than conventional FFDM in terms of demonstrating microcalcifications, as shown in 92.2% of cases.

Breast microcalcifications are one of the most important mammographic findings related to the existence of the breast cancer. Radiologists usually characterize microcalcifications based on their morphologies, the distribution within the cluster they form, the shape of the cluster and its relative location inside the breast. In this study, we focus on the latter factor and we study its effect on the probability of malignancy. The main purpose of our study is to generate probabilistic breast cancer atlases for clusters of microcalcifications in order to visualize the influence of cluster location on cancer probability. We propose a framework for the generation of such atlases, including segmentation of important breast landmarks and projection of different clusters of microcalcifications on a reference breast shape. The generation of the atlases is implemented using mammograms from the Digital Database of Screening Mammography. The obtained probabilistic atlases reveal specific areas in the breast of higher occurrence of clusters and higher risk of malignancy.

Imaging breast microcalcifications is crucial for early detection and diagnosis of breast cancer. It is challenging for current clinical ultrasound to image breast microcalcifications. However, new imaging techniques using data acquired with a synthetic-aperture ultrasound system have the potential to significantly improve ultrasound imaging. We recently developed a super-resolution ultrasound imaging method termed the phase-coherent multiple-signal classification (PC-MUSIC). This signal subspace method accounts for the phase response of transducer elements to improve image resolution. In this paper, we investigate the clinical feasibility of our super-resolution ultrasound imaging method for detecting breast microcalcifications. We use our custom-built, real-time synthetic-aperture ultrasound system to acquire breast ultrasound data for 40 patients whose mammograms show the presence of breast microcalcifications. We apply our super-resolution ultrasound imaging method to the patient data, and produce clear images of breast calcifications. Our super-resolution ultrasound PC-MUSIC imaging with synthetic-aperture ultrasound data can provide a new imaging modality for detecting breast microcalcifications in clinic without using ionizing radiation.

Purpose The aim of this study was to evaluate the relevance of the three-dimensional (3D) structure of breast microcalcifications (MC) as a predictor of malignancy using highly resolved micro-computed tomography (micro-CT) datasets of biopsy samples. Material and Methods The study included 28 women with suspicious MC in their mammogram undergoing vacuum-assisted biopsy. Directly after the intervention, the specimens were scanned in a micro-CT with an isometric spatial resolution of 9 μm. Datasets were analysed regarding the number, volume and morphology of suspicious non-monomorphic MC (fl—fine linear, fp—fine pleomorphic, ch—coarse heterogeneous) and the structure model index (SMI). Histological evaluation was performed according to the B-classification: normal tissue or benign (group A: B1, B2), unclear malignant potential or suspicious of malignancy (group B: B3, B4) and malignant lesions (group C: B5). Results In all groups, suspicious non-monomorphic MC were found: group A exhibited fp MC in 38.5% of samples, no fl/ch; group B: fl 14.3%, fp 28.6%, ch 14.3%; group C always had at least one type of suspicious non-monomorphic MC (fl (57.1%) or fp (57.1%)) in each sample. The different histologic groups showed a similar mean SMI (benign: 2.97 ± 0.31, malignant: 3.02 ± 0.10, unclear: 2.90 ± 0.28). Between the three groups, no significant differences were found regarding number, volume or SMI value of MC. Conclusion 3D structure based on the SMI of MC analysed with highest spatial resolution is not significantly associated with the B-classification of breast lesions. Thus, magnification views of MC may be omitted in the analysis of MC detected in mammograms.

Purpose: The purpose of this study is to compare the visibility of microcalcifications of digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) using breast specimens. Materials And Methods: Thirty-one specimens’ DBT and FFDM were retrospectively reviewed by four readers. Results: The image quality of microcalcifications of DBT was rated as superior or equivalent in 71.0% by reader 1, 67.8% by reader 2, 64.5% by reader 3, and 80.6% by reader 4. The Fleiss kappa statistic for agreement among readers was 0.31. Conclusions: We suggest that image quality of DBT appears to be comparable with or better than FFDM in terms of revealing microcalcifications.

To determine if the specimen without calcification, as depicted on specimen radiography, made any contribution to the final histopathological diagnosis in comparison to the specimen with calcification. The records of 1312 stereotactic vacuum-assisted biopsies for breast microcalcifications between February 2000 and December 2010 were reviewed retrospectively. Following specimen x-ray the biopsy tissues with and without microcalcifications were sent in two separate pots (pot 1 and pot 2 respectively). The number of cores in each pot and the number of calcium specks within the cores were recorded. In 1135 of the 1312 (86%) cases the histopathological findings were similar for pot 1 and pot 2. In 165 cases (13%) the diagnosis was made solely on pot 1 while cores in pot 2 did not reveal any additional pathology. In 12 biopsies (1%) the significant pathology was only present in the specimen without any calcification. For "microcalcification only" breast lesions the specimen containing calcium will yield a correct diagnosis in 99% of cases. Cores containing no calcification rarely contribute to the diagnosis on their own, but in 87% of cases an accurate diagnosis would still have been made even if the targeted calcification had been missed.