• D'Orsi C, Bassett LW, Berg WA, Bohm-Velez M, Evans WP III, Farria DM, Lee C, Mendelson E, Goldstein S, Expert Panel on Women's Imaging. Breast microcalcifications. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 12 p. [17 references]

This is the current release of the guideline.

It updates a previously published version: Cardenosa G, Mendelson E, Bassett L, Bohm-Velez M, D'Orsi C, Evans WP 3rd, Monsees B, Thurmond A, Goldstein S. Appropriate imaging work-up of breast microcalcifications. American College of Radiology. ACR Appropriateness Criteria. Radiology. 2000 Jun;215 Suppl:973-80.

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

ACR Appropriateness Criteria®

Clinical Condition: Breast Calcifications

Variant 1: Pleomorphic, fine, linear, branching in any distribution.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 2: Documentation of skin calcification.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 3: Milk of calcium, any distribution.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 4: Amorphous, single cluster.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 5: Amorphous, multiple cluster, one breast.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 6: Amorphous, multiple bilateral clusters.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 7: Amorphous in a regional distribution.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 8: Amorphous in a linear or segmental distribution.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 9: Course (popcorn), large rod-like, dystrophic, suture, lucent-centered, egg shell rim.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 10: Round or punctate, clustered.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 11: Round or punctate, regional.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 12: Punctate calcifications in a linear or segmental distribution.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 13: Punctate and amorphous, diffuse, bilateral.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 14: Course heterogeneous, single cluster.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 15: Course heterogeneous, multiple clusters, one breast.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 16: Course heterogeneous, multiple bilateral clusters.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 17: Course heterogeneous, in regional distribution.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 18: Course heterogeneous, in linear or segmental distribution.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Currently, ductal carcinoma-in-situ (DCIS) represents 25%-30% of all reported breast cancers. Approximately 95% of all DCIS is diagnosed because of mammographically detected microcalcifications. Prior to the widespread use of screening mammography, DCIS, detected as a mass on physical examination, was an uncommon disease representing less than 3% of all breast cancers. Screening mammography is the only reliable tool available for the detection of breast microcalcifications and DCIS.

Breast microcalcifications are detected commonly on screening mammograms. Most breast calcifications are benign and can be classified accordingly without any additional work-up. In women with indeterminate or malignant calcifications on screening studies, micro-focus (0.1 mm focal spot) magnification views in orthogonal projections are useful.

On magnification images, additional calcifications may be apparent, the morphology of individual calcifications can be characterized, and the distribution of calcifications can be better determined. In women with malignant calcifications, magnification images may be helpful in establishing the extent of disease.

Currently, the role for computer-aided detection (CAD) of calcifications has not yet been determined. However, recent studies indicate that computer-aided detection can be clinically useful to avoid false negatives when used properly.

Stereotactically guided core biopsy using a variety of devices can sample areas of microcalcifications. Stereotactically guided FNA of microcalcifications has been shown to be inaccurate. Core biopsy specimen radiographs should be done to establish the presence of calcifications in the core, as is done with surgically excised specimens.

Abbreviations

• CC, cranial-caudal
• FNA, fine needle aspiration
• INV, invasive
• IP, in progress
• MRI, magnetic resonance imaging
• NUC, nuclear medicine
• US, ultrasound

Algorithms were not developed from criteria guidelines.

The recommendations are based on analysis of the current literature and expert panel consensus.

• D'Orsi C, Bassett LW, Berg WA, Bohm-Velez M, Evans WP III, Farria DM, Lee C, Mendelson E, Goldstein S, Expert Panel on Women's Imaging. Breast microcalcifications. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 12 p. [17 references]

Not applicable: The guideline was not adapted from another source.

1996 (revised 2005)

American College of Radiology - Medical Specialty Society

The American College of Radiology (ACR) provided the funding and the resources for these ACR Appropriateness Criteria®.

Committee on Appropriateness Criteria, Expert Panel on Women's Imaging--Breast Work Group

Panel Members: Carl D'Orsi, MD; Lawrence W. Bassett, MD; Wendie A. Berg, MD, PhD; Marcela Bohm-Velez, MD; W. Phil Evans III, MD; Dione Marie Farria, MD, MPH; Carol Lee, MD; Ellen Mendelson, MD; Steven Goldstein, MD

Not stated

This is the current release of the guideline.

It updates a previously published version: Cardenosa G, Mendelson E, Bassett L, Bohm-Velez M, D'Orsi C, Evans WP 3rd, Monsees B, Thurmond A, Goldstein S. Appropriate imaging work-up of breast microcalcifications. American College of Radiology. ACR Appropriateness Criteria. Radiology. 2000 Jun;215 Suppl:973-80.

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

None available

This NGC summary was completed by ECRI on February 13, 2006.