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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.

Background: Specimen radiography is important for the biopsy of breast microcalcifications, and MRI is limited in the detection of microcalcifications. It is unknown whether or not the presence of microcalcifications on MRI-guided biopsies is significant. Purpose: To determine whether specimen radiography of MRI-guided biopsy samples provides any added benefits in tissue assessment. Materials and Methods: This is an IRB-approved, HIPPA-compliant retrospective review of MRI-guided biopsy reports whose tissue underwent specimen radiography from 2010 to 2017. Pathology reports were queried to compare samples with and without calcium and reviewed to determine if calcifications correlated with the lesion of interest. If there was a correlation, the original MRI was reviewed. Final pathology reports were also reviewed if excision was performed. Results: A total of 889 patients ages 22 - 85 were included with 140 (15.7%, 140/889) containing calcifications. Of 140 specimens, 119 (85.0%, 119/140) cases separated the calcifications. A total of 41 (34.5%, 41/119) were malignant or high-risk lesions/atypia of which 15 (36.6%, 15/41) showed a higher-grade lesion in the specimen containing calcium. Out of these 15, 4 (26.7%, 4/15) were pathologically associated with calcium; however, pathologic diagnosis was not dependent on the presence of calcifications. All 4 were high-risk lesions and none were malignancies. MRI in these cases showed three enhancing masses and one non-mass enhancement. None were upgraded at excision. Conclusion: The presence of microcalcifications on MRI-guided biopsies does not aid in tissue assessment and does not impact pathologic diagnosis. Specimen radiography provides no added benefits in the setting of MRI-guided biopsies.

Objective: Ultrasonography guided core needle biopsy is a real-time, inexpensive method with higher patient comfort. The aim of this study was to evaluate ultrasonography findings of microcalcifications without accompanying mass and also to investigate the accuracy of ultrasonography guided core needle biopsy results. Materials and Methods: The study included a total of 54 patients, with microcalcifications observed on mammography and no accompanying mass, who underwent ultrasonography guided core needle biopsy and surgical excision. Core needle biopsy specimen x-rays were obtained from 23 patients. In 11 patients, the location of microcalcification was confirmed by mammography following the administration of contrast agent under ultrasonography guidance. Ultrasonography findings of microcalcifications were identified. The results of ultrasonography guided core needle biopsy were compared with the excisional pathology results. Results: The microcalcifications without accompanying mass were presented with punctate echogenous foci, hypoechoic area, small distortion, ductal abnormality or fibrocystic changes on ultrasonography. Hypoechoic area and distortion were seen more in malignant lesions, and fibrocystic changes and ductal abnormalities in benign lesions but the difference was not statistically significant. The agreement between ultrasonography guided core needle biopsy and the excisional pathology results was high (Kappa = 0.781). When a specimen x-ray was obtained or core needle biopsy was performed after confirming the location of the microcalcifications with the use of contrast agent, Kappa values were even higher (0.87 and 1, respectively). Conclusions: Microcalcifications can be seen with targeted ultrasonography imaging and ultrasonography guided core needle biopsy has high accuracy. Taking a specimen x-ray, or biopsy performed after identifying of the location of microcalcifications with a trace amount of contrast agent, can increase the accuracy of ultrasonography guided core needle biopsy.

Background Clinical response evaluation by image examination after neoadjuvant chemotherapy for breast cancer is important for determining drug response and progression. Mammography is less correlated with pathologic response assessment than magnetic resonance imaging or ultrasonography. The present study clarified characteristics of breast cancer patients with decreased microcalcifications after neoadjuvant chemotherapy to increase the accuracy of mammographic assessment. Patients and Methods Consecutive patients who received neoadjuvant chemotherapy for breast cancer at our hospital from January 2013 to June 2017 were retrospectively reviewed. Characteristics of cases of microcalcifications before neoadjuvant chemotherapy and those showing a reduction after were examined. Stromal tumor-infiltrating lymphocytes were evaluated in the biopsy. Pathologic complete response was also explored in patients exhibiting a decrease in microcalcifications by neoadjuvant chemotherapy. Results Seventy breast cancer cases were included; 37 had no malignant microcalcifications before neoadjuvant chemotherapy and 33 did. Breast cancer with microcalcifications was significantly more positive for human epidermal growth factor receptor 2 than those without microcalcifications (48% vs. 22%, P = .018). Only 6 of 33 patients with microcalcifications before neoadjuvant chemotherapy showed a decrease after treatment. These patients tended to have high stromal tumor-infiltrating lymphocytes (50% vs. 17%), segmental microcalcifications (66% vs. 33%), and pleomorphic/linear microcalcifications (83% vs. 37%). Conclusion These results suggest that neoadjuvant chemotherapy is able to decrease malignant calcifications, particularly segmental and pleomorphic/linear microcalcifications. By clarifying the mechanisms of formation and disappearance of microcalcifications, a consensus can be reached on whether microcalcifications apparent by mammography are useful for evaluating response to neoadjuvant chemotherapy.

Mimics of calcifications on mammography are not uncommon and result in additional investigations that can cause patient anxiety. We describe the case of a 63 year old male who underwent further investigation of calcifications in the superior right breast. Additional imaging and patient examination revealed that the calcifications were located in a color tattoo overlying the medial right pectoralis muscle and actually represented the radio-opaque metallic compounds found in tattoo pigment.

In the framework of computer-aided diagnosis of breast cancer, many systems were designed for the detection, the classification and/or the content-based mammogram retrieval (CBMR); in order to serve as a second source of decision for the radiologists. Nevertheless, to improve the final decision-making, the concept of multi-view information fusion (MVIF) was recently introduced. Indeed, this concept has been successfully applied in the context of breast cancer, since screening mammography provides two views for each breast: MedioLateral-Oblique (MLO) and CranioCaudal (CC) views. As these two views are complementary, MVIF methods widely proved their effectiveness. In this paper, we review the main methods that have been proposed for MVIF in the context of the detection (abnormality vs. non abnormality), the classification (normal vs. benign vs. malignant) and the content-based retrieval of mammograms. In fact, we classified detection based on MVIF methods into two main sub-classes, including ipsilateral analysis and bilateral analysis. Besides, classification based on MVIF methods were regrouped into two sub-classes, namely classification of breast masses based on MVIF and classification of breast microcalcifications based on MVIF. Lastly, CBMR based on MVIF methods were also classified into two sub-classes: early fusion-based MVIF-CBMR and late fusion-based MVIF-CBMR.

Background: microcalcifications (MC) are common findings on screening mammography and are among the earliest signs of breast cancer. At the same time, from the use of well-known radiographic risk score systems, which include MC assessment, such as Breast Imaging-Reporting and Data System (BI-RADS), only 20% of screened patients are further associated with malignancy. This leads to repeated biopsies and to unnecessary surgeries with discomfort for patients and increased costs for the healthcare system. Furthermore, the definitive diagnosis by histological and immunohistological evaluations is still laborious and time-consuming. Raman Spectroscopy (RS) is a photonic approach capable to provide detailed chemical information of analysed samples without complex tissue preparation or staining. RS has a proven ability to distinguish different crystal structures, including those commonly present in MC. In this context some studies based on RS suggested a correlation between MC chemical features and pathology. On the other hand, previous Raman-based studies mainly investigated the overall MC chemical composition (by single-point scans) while an extensive MC characterization by Raman imaging approaches (mapping) for diagnostic purposes is still lacking. The aim of this study is to assess the usefulness of Raman imaging as a quick and accurate tool for a complete spatial characterization of MC detected on screening mammography and sampled by breast biopsy in order to better distinguish malignant vs. benign lesions. Method: 30 patients with breast calcifications detected on mammography with radiological classification BI-RAD 3-5 where selected and evaluated by core biopsy. 10 μm formalin-fixed paraffin-embedded (FFPE) histological sections obtained from biopsies were dewaxed with a specifically developed protocol that allows the removal of paraffin in less than 15 minutes. All MC present in each tissue section (usually from 2 to >10 per section) were then characterized by a Raman microscope thus obtaining Raman maps with lateral resolution between 5 and 10 μm. After pre-processing steps the Raman maps were analysed by both clustering and multivariate analysis approaches used to produce false-colour images and to perform automated features identification. Results: Our results confirm that hydroxyapatite is the prevalent form of calcium phosphate in MC and that MC composition correlates with lesion malignancy. In addition, thanks to the Raman imaging approach used here, we report for the first time that hydroxyapatite is more homogeneously distributed in malignant lesions and that, on the contrary, benign lesions show a heterogeneous distribution of hydroxyapatite, whitlockite and calcium-carbonate, inside the lesion and in the surrounding tissue. Conclusion: These evidences suggest that the characterization of MC by Raman imaging is a potential tool for the definition of new diagnostic signatures of breast cancer, especially if we consider that these evaluations can be performed by the simple and relative fast scanning of dewaxed slices, without altering the clinical workflow and without the need of staining or antibodies. Further studies with a larger cohort will be done to validate these results. Citation Format: Vanna R, Morasso C, Piccotti F, Sorrentino L, Villani L, Torti E, Bonizzi A, Leporati F, Corsi F. Raman imaging as a tool for the chemical and spatial characterization of breast microcalcifications to improve lesion assessment [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-20-05.

BACKGROUND: At present, most histological evaluations of microcalcifications without a mass are performed using X-ray guided hook wire localization or vacuum-assisted stereotactic biopsy (VASB), but there are still several limitations to these techniques. Therefore, we designed a visualization positioning technique based on three directions of mammography to accurately locate suspected microcalcifications to guide the biopsy. METHODS: We retrospectively analyzed consecutive patients with suspicious microcalcifications who underwent visualization positioning-guided biopsy (VPB) from June 1, 2016, to June 1, 2021. The visualization positioning technique was performed using an electronic ruler to measure the vertical distance from the microcalcification core to the vertical lines on mammography. RESULTS: A total of 133 patients (median age 46 years; range, 22–87 years) who underwent VPB were included in our study. Among the 133 cases of microcalcifications based on pathological results, 104 were benign, 14 were high risk, and 15 were malignant. In 124 (93.2%) patients, microcalcification was confirmed during the first round of VPB specimen analysis. Only 6 (4.5%) and 3 (2.3%) patients underwent second and third extended resections, respectively, as the resected specimens did not contain microcalcifications. Four patients (3.0%) with malignant biopsy results underwent a subsequent operation. Two patients with DCIS underwent mastectomy and sentinel lymph node biopsy because of diffuse calcification. One patient had no residual cancer, and the other was upgraded to invasive ductal carcinoma (IDC). Two patients with IDC underwent breast-conserving surgery and mastectomy with sentinel lymph node biopsy. CONCLUSIONS: VPB can be used to evaluate breast microcalcifications when a mass is not present, making it an effective diagnostic technique.

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. Abstract 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.

(1) Background: Considering highly selected patients with ductal carcinoma in situ (DCIS), active surveillance is a valid alternative to surgery. Our study is aimed at showing the reliability of post-biopsy complete lesion removal, documented by mammogram, as additional criterion to select these patients. (2) Methods: 2173 Vacuum Assisted Breast Biopsies (VABB) documented as DCIS have been reviewed. Surgery has been 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. (3) Results: We observed 2173 cases of DCIS: 408 classified as low grade; 1262 as intermediate grade; 503 as high grade. The overall upgrading rate to invasive carcinoma was 15.2% (330/2173). The upgrade rate was significantly lower (8.2%) when considering patients showing mammographically documented complete removal of the lesion. (4) Conclusion: The absence of mammographically documented residual lesion following VABB is associated to a lower upgrading rate of DCIS to invasive carcinoma on surgical excision and should be considered when deciding the proper management DCIS diagnosis.

Breast cancer is the most common cancer among women and the second leading cause of female cancer mortality following lung cancer. Breast cancer also affects men but with a low incidence rate. However, the survival rate for men is much lower than women's. Early screening to identify breast abnormalities can increase the survival rate. Since the causes of this disease are not all known, primary prevention seems impossible. Therefore, early detection is the major key to surviving this disease. If breast cancer is detected earlier, there are more treatment options and a better chance for survival. The first sign of numerous breast cancer cases is the presence of microcalcifications in mammograms, which are small crystals of calcium apatites ranging from 0.1 mm to 0.5 mm. In this paper, we propose a multi-objective optimization approach to determine the optimal boundary between the signal subspace and noise subspace in TR-MUSIC algorithm.

We present a case of a 65 year old female with newly diagnosed primary peritoneal serous carcinoma who was found to have indeterminate segmental microcalcifications in the right upper outer quadrant with a mildly enlarged right axillary node on mammogram. There was no associated breast mass on ultrasound. Core biopsy of the right axillary lymph node and right upper outer quadrant breast microcalcifications confirmed the presence of breast metastases at both sites from primary peritoneal serous carcinoma. This case highlights the importance of histopathological correlation of any breast and axillary abnormalities in patient with primary extramammary malignancy. Imaging features of metastatic lesions to the breast are also reviewed.

Resumen Objetivo Verificar si el artefacto de twinkle (AT) se corresponde con la presencia de microcalcificaciones previamente vistas mediante mamografia, y valorar su utilidad en el manejo ecografico de microcalcificaciones sospechosas. Material y metodos Hemos examinado prospectivamente mediante ecografia a 46 pacientes consecutivas con grupos de microcalcificaciones sospechosos de malignidad, sin otros hallazgos mamograficos de sospecha, buscando la presencia del AT para identificar las microcalcificaciones. Cuando lo conseguimos, procedimos a biopsiarlas con aguja gruesa (BAG) 11G, y posteriormente comprobamos la presencia de las microcalcificaciones mediante radiografia de las muestras obtenidas. Analizamos el porcentaje de deteccion y obtencion de microcalcificaciones con la BAG, usando esta tecnica, asi como la concordancia radiopatologica. Las microcalcificaciones no detectadas con ecografia, o no concordantes, fueron biopsiadas mediante estereotaxia en otro centro. Tambien utilizamos guia ecografica para el marcaje preoperatorio con arpones, orientandolos habitualmente de forma radial. Resultados Se identificaron y biopsiaron con ecografia 41 de las 46 lesiones, incluyendo 24 de los 25 carcinomas (17 de ellos in situ). La ecografia en modo B basto para biopsiar las microcalcificaciones en 14 pacientes, aunque en 6 de ellas el AT incremento el numero de microcalcificaciones detectadas, lo que permitio un marcaje preoperatorio mas preciso. Gracias al AT identificamos 27 grupos adicionales (89% vs. 30%; p Conclusiones El AT es una herramienta util para la identificacion ecografica de microcalcificaciones, lo que permite un significativo incremento de las biopsias guiadas por ecografia, asi como una mejor delimitacion preoperatoria.

Objective: In the UK RCR 5-point breast imaging system (UKS), radiologists grade mammograms from 1 to 5 according to suspicion for malignancy, however unlike BI-RADS, no lexicon of descriptors is published. The aim of this study was to determine whether strict categorisation of microcalcifications (MCC) according to BI-RADS was a better predictor of malignancy than the UKS and whether these descriptors could be used within the UKS. Methods: A retrospective review of 241 cases, with MCC on mammography, who underwent biopsy was performed. Morphology, distribution, extent, UKS score, BI-RADS category and pathology were recorded. The positive predictive value (PPV) of each classification system for malignancy was calculated. Results: 28.6% were diagnosed with DCIS/IDC. The PPV for malignancy using the UKS was 18.9%, 69.4%, 100% for M3-5 respectively (p < 0.001) and using ΒI-RADS morphology was amorphous: 7.1%, coarse heterogeneous: 33.3%, fine pleomorphic: 48.1% and fine linear/fine linear branching: 85.2% (p < 0.001). The PPV based on distribution was grouped: 14.2%, regional: 32.3%, diffuse: 33.3% and linear/segmental: 77.8% (p < 0.001). Combining all cases of benign-appearing, amorphous and grouped coarse heterogenous and grouped fine pleomorphic MCC gave a PPV of 12.8%. Combining regional, linear or segmental coarse heterogenous and fine pleomorphic and all fine linear/branching MCC resulted in a PPV of 83.3% for malignancy. Conclusion: Combining morphology and distribution of MCC is accurate in malignancy prediction. Use of BI-RADS descriptors could help standardise reporting within the UKS and an algorithm using these within the UKS is proposed. Better prediction would enable more appropriate counselling and help to identify discrepancies. Advances in knowledge: No guidance exists on scoring of suspicious MCC in the UK breast imaging system. Use of BI-RADS morphologic/distribution descriptors can aid malignancy prediction. Findings other than morphology of MCC are important in malignancy prediction. An algorithm for use by the UK radiologist when evaluating MCC is provided.

Breast microcalcifications are one of the important imaging features of early breast cancer and are a key to early breast cancer diagnosis. Ultrasound imaging has been widely used in the detection and diagnosis of breast diseases because of its low cost, nonionizing radiation, and real-time capability. However, due to factors such as limited spatial resolution and speckle noise, it is difficult to detect breast microcalcifications using conventional B-mode ultrasound imaging. Recent studies show that new ultrasound technologies improved the visualization of microcalcifications over conventional B-mode ultrasound imaging. In this paper, a review of the literature on the ultrasonic detection methods of microcalcifications was conducted. The reviewed methods were broadly divided into high-frequency B-mode ultrasound imaging techniques, B-mode ultrasound image processing techniques, ultrasound elastography techniques, time reversal techniques, high spatial frequency techniques, second-order ultrasound field imaging techniques, and photoacoustic imaging techniques. The related principles and research status of these methods were introduced, and the characteristics and limitations of the various methods were discussed and analyzed. Future developments of ultrasonic breast microcalcification detection are suggested.

Breast cancer is the most common type of cancer among women and it is the major cause of female cancer-related deaths worldwide. Microcalcifications, which are small crystals of calcium apatites, are considered the first sign of breast cancer in more than half of all breast cancer cases. Since these calcium apatites are very small and may be easily overlooked by the radiologists, automatic image processing systems can help radiologists in early diagnosis of breast cancer. In these systems, detection and segmentation of breast microcalcifications from the background tissue are important steps. The purpose of this work is to evaluate the performance of several breast microcalcifications segmentation techniques and select the best technique using a multicriteria decision making approach. The approaches were applied on 630 mammograms from the Digital Database for Screening Mammography. Of the 630 images, 315 images correspond to malignant cases and 315 correspond to benign cases. The efficiency of the considered techniques was evaluated by using five metrics, namely a similarity index, the extra overlap fraction, sensitivity, specificity, and accuracy.

In this paper we examine data fusion methods for multi-view data classification. We present a decision concept which explicitly takes into account the input multi-view structure, where for each case there is a different subset of relevant views. This data fusion concept, which we dub Mixture of Views, is implemented by a special purpose neural network architecture. It is demonstrated on the task of classifying breast microcalcifications as benign or malignant based on CC and MLO mammography views. The single view decisions are combined by a data-driven decision, according to the relevance of each view in a given case, into a global decision. The method is evaluated on a large multi-view dataset extracted from the standardized digital database for screening mammography (DDSM). The experimental results show that our method outperforms previously suggested fusion methods.

The purpose of this study was to evaluate the feasibility of spectral mammography using the dual-energy method to noninvasively distinguish between type I (calcium oxalate, CO) and type II (calcium hydroxyapatite, HA) microcalcifications. Two types of microcalcifications are difficult to distinguish due to a similar linear attenuation coefficient. In order to improve the detection efficiency of microcalcifications, we used the photon counting detector with energy discrimination capability and microcalcifications were classified into optimal energy bins. Two energy bins were used to obtain dualenergy images. In this study, photon counting spectral mammography system was simulated using Geant4 Application for Tomographic Emission (GATE) simulation tools. The thickness of the breast phantom was 3 cm and microcalcifications of various sizes ranging from 130-550 μm were embedded into the breast phantom. Microcalcifications were classified as being calcium hydroxyapatite or calcium oxalate based on score calculation with the dual-energy images. According to the results, the measured CNR of calcium hydroxyapatite (HA) was higher than that of the calcium oxalate (CO) in conventional single-energy image. In addition, two types of microcalcifications were distinguished using dual-energy analysis method. This classification represents better performance with a high energy of 50 kVp and an energy threshold of 30 keV. These results indicate that the classification performance was improved when the difference in the low energy image and high energy image was used. This study demonstrated the feasibility of photon counting spectral mammography for classification of breast microcalcifications. We expect that dual-energy method can reduce the frequency of biopsy and discriminate microcalcifications in mammography. These results are expected to potentially improve the efficiency of early breast cancer diagnosis.

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 &lt, 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.

Background: Clinical response evaluation by image examination after neoadjuvant chemotherapy for breast cancer is important for determining drug response and progression. Mammography is less correlated with pathological response assessment than magnetic resonance imaging or ultrasonography particularly because mammographic calcifications can increase or decrease in response to neoadjuvant chemotherapy. A conventional theory of breast microcalcifications is that they are likely to paradoxically change with neoadjuvant chemotherapy. Traditionally, microcalcifications have been said to occur due to necrosis. If conventional theory is correct, the increase in necrotic cells would increase microcalcifications in response to neoadjuvant chemotherapy. However, decreased microcalcifications were found as a clinical response to neoadjuvant chemotherapy in many cases. To increase the diagnostic ability of mammography after neoadjuvant chemotherapy, it is important to clarify the cases in which microcalcifications can be reduced by anticancer agents. The present study clarified characteristics of breast cancer cases with decreased microcalcifications after neoadjuvant. Methods: Consecutive patients who received neoadjuvant chemotherapy for breast cancer at our hospital from January 2013 to June 2017 were retrospectively reviewed. Characteristics of cases with microcalcifications before neoadjuvant chemotherapy and those showing a reduction after were examined. Stromal tumor-infiltrating lymphocytes were evaluated in the biopsy. before neoadjuvant chemotherapy based on the protocol of the International TILs Working Group 2014. Pathological complete response was also explored in cases exhibiting a decrease in microcalcifications by neoadjuvant chemotherapy. In addition, sensitivity, specificity, and likelihood ratios were calculated for pCR assessment in patients with segmental microcalcifications, pleomorphic/linear microcalcifications, and microcalcifications without mammographic mass. Results: A total of 184 breast cancer cases, including 8 with synchronous bilateral breast cancer, received neoadjuvant chemotherapy at our hospital. Of them, 114 cases were excluded due to unavailable mammograms at our institute before or after neoadjuvant chemotherapy. Seventy breast cancer cases were included; 37 had no malignant microcalcifications before neoadjuvant chemotherapy and 33 did. Breast cancer with microcalcifications was significantly more positive for human epidermal growth factor receptor 2 than those without microcalcifications (48% versus 22%, P = 0.018). Only 6 out of 33 cases with microcalcifications before neoadjuvant chemotherapy showed a decrease after treatment. These cases tended to have high stromal tumor-infiltrating lymphocytes (50% versus 17%), segmental microcalcifications (66% versus 33%), and pleomorphic/linear microcalcifications (83% versus 37%). The sensitivity of each group, compared with total cases of microcalcifications after neoadjuvant chemotherapy, tended to increase, although no significant difference was observed (sensitivity; patients with segmental microcalcifications, 42.9%; patients with pleomorphic/linear microcalcifications, 57.1%; and patients with microcalcifications but without mass, 50.0%). Conclusion: These results suggest that neoadjuvant chemotherapy is able to decrease malignant calcifications, particularly segmental and pleomorphic/linear microcalcifications and microcalcifications with high stromal tumor-infiltrating lymphocytes. By clarifying the mechanisms of formation and disappearance of microcalcifications, a consensus can be reached on whether microcalcifications apparent by mammography are useful for evaluating response to neoadjuvant chemotherapy. Citation Format: Atsushi Fushimi, Rei Kudo, Hiroshi Takeyama. Do decreased breast microcalcifications after neoadjuvant chemotherapy predict pathological complete response? [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-01-02.

Url: http://sujest.selcuk.edu.tr/sumbtd/article/view/461 DOI: 10.15317/Scitech.2018.138, An automated computer aided diagnosis system has been proposed for detection of microcalcification (MC) clusters in mammograms. The proposed system is a whole system including suspicious regions identification, MCs detection, false positive reduction and benign/malign classification. For classification of suspicious microcalcification regions, a multilayer perceptron (MLP) neural network was used with grey level co-occurrence matrix (GLCM) and statistical features. Then to decrease the false positive classification ratio, we used cascade correlation neural network (CCNN) with grey level run length matrix (GLRLM) features. In the last step, hybrid form of discriminant analysis and support vector machine (SVM) methods were used with GLRLM features for benign/malign classification of detected MC clusters. The open access Mammographic Image Analysis Society (MIAS) database was used for the study. Experimental results show that the proposed algorithm obtained 86% sensitivity, 98.3% specificity and 1.163 FPpI rates for detection an for diagnosis of breast cancer, the obtained sensitivity and specificity values are 100% and 100% respectively. Despite the vision difficulty of MC clusters, the novel system provides very satisfactory results. Furthermore, the developed system is fully automatic whole system which gives outputs as percentages and transformed assessment categories., Mamografide mikrokalsifikasyon (MC) kümelerinin saptanması için otomatik bir bilgisayar destekli tanı sistemi önerilmiştir. Önerilen sistem şüpheli bölgelerin tanımlanması, MC'lerin tespiti, yanlış pozitif indirgeme ve iyi huylu/kötü huylu sınıflamayı içeren bütün bir sistemdir. Şüpheli mikrokalsifikasyon bölgelerinin sınıflandırılması için, gri seviye eş-oluşum matrisi (GLCM) ve istatistiksel özellikler ile çok tabakalı bir perceptron (MLP) sinir ağı kullanıldı. Daha sonra, yanlış pozitif sınıflandırma oranını azaltmak için, gri seviye çalışma uzunluğu matrisi (GLRLM) özellikli kademeli korelasyon sinir ağı (CCNN) kullanılmıştır. Son adımda, tespit edilen MC kümelerinin iyi huylu/kötü huylu sınıflandırması için GLRLM özellikleri ile hibrid yapıda diskriminant analizi ve destek vektör makinesi (SVM) yöntemleri kullanıldı. Çalışma için açık erişimli Mamografik Görüntü Analizi Derneği (MIAS) veri tabanı kullanılmıştır. Deneysel sonuçlar, önerilen algoritmanın meme kanseri tespiti için %86 duyarlılık, %98.3 özgüllük ve 1.163 FPpI oranları elde ettiğini ve meme kanseri tanısı için elde edilen duyarlılık ve özgüllük değerlerinin sırasıyla %100 ve %100 olduğunu ortaya koymuştur. MC kümelenmelerinin görme zorluğu olsa da, önerilen sistem çok tatmin edici sonuçlar vermektedir. Bununla birlikte, gelişmiş sistem; çıktıları yüzdeler ve dönüştürülmüş değerlendirme kategorileri olarak veren tam otomatik bir bütün sistemdir.

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.

The aim of the present study was to improve the conventional wire-guided localization biopsy (WGLB) of breast microcalcifications to overcome disadvantages associated with the procedure, including inaccurate localization and large specimen volume. The novel approach described in the present study was termed double wire-guided localization and rotary cutting biopsy (DWGLB). Prior to surgery, the precise localization of the lesions was assessed using two wires under the assistance of mammography X-ray and ultrasound, followed by complete excision of the lesions using a novel rotary cutting tool. The cylindrical specimen was placed on a scaled specimen holder for pathological examination. DWGLB was performed in 108 patients with the classification of as Breast Imaging Reporting and Data System score 4A. Percutaneous localization of the lesions guided by a mammography X-ray and ultrasound were successful in all 108 lesions (100%) with one puncture attempt. The lesions were precisely excised in all of 108 patients, and included 13 malignant lesions (DCIS of breast in 7 cases, DCIS with focal invasive carcinoma in 3 cases and invasive ductal carcinoma in 3 cases). The average distance of the BARD Dualok to the lesion was 4.1 mm; the average weight of specimens was 8.5 g. Compared with WGLB, DWGLB offers several advantages, including more accurate localization of lesions, a more standardized biopsy method and a smaller specimen volume. DWGLB can also provide the precise position of lesions in the specimen for further pathological examination.

Aim The present study compares the effect and accuracy of the superficial mark guided localization (SGL) and hook-wire guided localization (WGL) techniques for non-palpable breast microcalcifications. Methods This retrospective study was conducted to compare SGL and WGL techniques. These techniques were performed on 51 patients with non-palpable breast microcalcifications from January 2015 to May 2016. Results Among these 51 patients, 25 (49.01%) patients were subjected to WGL and 26 patients (50.99%) were subjected to SGL. The SGL technique had a higher rate of malignant cancer detection (WGL = 12.0% and SGL = 23.0%). Furthermore, no significant differences were found with regard to average age, the rate of a second excision and the diameter of the excised tissue. Moreover, no complications were observed in the SGL group, while four (16.0%) patients in the WGL group experienced problems. Conclusion The SGL technique is as accurate as the WGL technique. Furthermore, the procedure has advantages of being less expensive and causing less complications.

Purpose: To investigate the potential of spectral mammography to distinguish between type I microcalcifications, consisting of calcium oxalate dihydrate compounds typically associated with benign lesions, and type II microcalcifications containing hydroxyapatite which are predominantly detected in malignant tumors. Methods: Simulation and phantom studies were carried out using polyenergetic spectra from a tungsten anode x-ray tube at low and high voltage (kVp) settings. Low- and high-energy attenuation ratios were calculated for microcalcifications of different types and thicknesses. Classification of type I or II calcifications was performed by using the attenuation ratio as a criterion. The results were evaluated using receiver operating characteristic (ROC) analysis. Results: In simulation studies, four combinations of dual (low and high kVp) energy exposure technique were investigated: 1) 30 kVp, 1 mm aluminum filtration and 50 kVp, 0.1 mm copper filtration; 2) 30 kVp, 1 mm Al and 50 kVp 0.2 mm Cu; 3) 30 kVp, 2 mm Al and 50 kVp, 0.1 mm Cu; and 4) 30 kVp 2 mm Al and 50 kVp, 0.2 mm Cu. In the ROC curve analysis, area under the curve (AUC) values were above 0.95 for all of the spectra with the exposure equivalent to 1.5 mGy of the mean glandular dose delivered to a 4 cm thick breast phantom. 30 kVp/2 mm Al and 50 kVp/0.1 mm Cu tube voltage/filter combinations demonstrated better performance compared to other combinations. In phantom studies, a 40 kVp setting paired with 1 mm Al filter and a 70 kVp setting paired with 0.1 mm Cu filter operated at 20 mAs technique were used. Obtained AUC value was also high (0.91), supporting the accuracy of the proposed classification method. Conclusion: The results of the current study suggest that dual energy mammography systems have potential to be used for discrimination between type I and type II microcalcifications to improve early breast cancer diagnosis and reduce the number of unnecessary breast biopsies.

Microcalcifications are an important hallmark of breast cancer and their composition correlates with the degree of pathology. This study used mid-infrared spectroscopic imaging to assess the chemical composition of breast microcalcifications to aid disease diagnosis.