Breast Microcalcifications as Type Descriptors to Stratify risk of Malignancy: a Systematic Review and Meta-Analysis of 10665 Cases with Special Focus on Round/Punctate Microcalcifications

Abstract

Purpose: To use a systematic review and meta-analysis to determine the predictive value of five suspicious type descriptors of microcalcifications, with special focus on round/punctate microcalcifications because of controversy.

Materials and Methods: We performed a literature search using three databases and one search engine. We screened citations for malignancy rates of type descriptors. We regarded malignancy rates below 2 % (BI-RADS 3) and above 95 % (BI-RADS 5) as clinically significant threshold values for suspicion (BI-RADS 4).

Results: Forty studies from 14 countries with a total of 10,665 microcalcification lesions were included. The pooled malignancy rates were: coarse heterogeneous, 13 % (95 % confidence interval (95 %-CI): 7 – 20 %); amorphous or indistinct, 27 % (95 %-CI: 21 – 33 %); pleomorphic, 50 % (95 %-CI: 43 – 58 %); linear, 78 % (95 %-CI: 68 – 86 %). The pooled malignancy rate of all round/punctate microcalcifications was 9 % (95 %-CI: 6 – 13 %), for the subgroup follow-up it was 0,5 % (95 %-CI: 0.08 – 2.57 %), and with histological verification it was 14 % (95 %-CI: 11 – 19 %). Woman selection and consideration of additional suspicious image findings were reasons for between-study heterogeneity. Addition of ACR distribution descriptors diversified risk stratification, but did not alter BI-RADS assessment category.

Conclusion: All suspicious type descriptors including round/punctate microcalcifications as well as combinations of type with suspicious distribution descriptors fell into BI-RADS assessment category 4. Exclusion of suspicious adjunct factors can direct clustered, round/punctate microcalcifications to a lower BI-RADS assessment category.

Zusammenfassung

Ziel: Erstellung eines systematischen Reviews und Metaanalyse zur Beurteilung des prädiktiven Vorhersagewerts von 5 suspekten Mikrokalktypen unter besonderer Berücksichtigung von rund/punktförmigem Mikrokalk aufgrund der Kontroverse.

Material und Methoden: Wir führten eine Literatursuche unter Verwendung von drei Datenbanken und einer Suchmaschine durch. Wir überprüften die Zitate auf Malignitätsraten von Mikrokalk. Wir betrachteten eine Malignitätsrate von unter 2 % (BI-RADS 3) und über 95 % (BI-RADS 5) als klinisch signifikante Schwellenwerte für suspekte Veränderungen (BI-RADS 4).

Ergebnisse: 40 Studien aus 14 Ländern mit insgesamt 10 665 Mikrokalkläsionen wurden eingeschlossen. Die gepoolten Malignitätsraten betrugen: grob heterogen, 13 % (95 %-Konfidenzintervall (95 %-KI): 7 – 20 %); amorph oder unscharf, 27 % (95 %-KI: 21 – 33 %); pleomorph, 50 % (95 %-KI: 43 – 58 %); linear, 78 % (95 %-KI: 68 – 86 %). Die gepoolte Malignitätsrate von rund/punktförmigen Mikrokalk betrug 9 % (95 %-KI: 6 – 13 %), für die Untergruppe Verlaufskontrolle 0,5 % (95 %-KI: 0,08 – 2,57 %) und für die Gruppe mit histologischer Abklärung 14 % (95 %-KI: 11 – 19 %). Vorauswahl der Frauen und Berücksichtigung weiterer suspekter Bildkriterien waren Gründe für die Studienheterogenität. Die zusätzliche Beurteilung des ACR-Verteilungsmusters verfeinerte die Risikostratifizierung, ergab jedoch keine Änderung der BI-RADS-Beurteilungskategorie.

Schlussfolgerung: Alle suspekte Verkalkungstypen inklusive rund/punkförmiger Mikrokalk sowie Kombinationen von Verkalkungs- mit suspekten Verteilungstypen liegen in der BI-RADS-Beurteilungskategorie 4. Nach Ausschluss jeglicher auffälliger Zusatzfaktoren kann gruppierter, rund/punktförmiger Mikrokalk in eine niedere BI-RADS-Kategorie fallen.

Key words

breast - mammography - calcifications/calculi

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