Detection of Microcalcifications in Women with Dense Breasts and Hypoechoic Focal Lesions: Comparison of Mammography and Ultrasound

Abstract

Purpose: Microcalcifications in the breasts can point to breast cancer. However, there is great morphologic variety, and microcalcifications do not always correlate with malignancy. We conducted a prospective study to compare ultrasound and mammography in the detection of microcalcifications following sonographic diagnosis of a hypoechoic focal lesion in women with dense breast composition.

Materials and Methods: A total of 104 lesions potentially associated with microcalcifications (82 malignant and 23 benign lesions) were included in the study. The breast was examined by ultrasound (9 MHz, Aplio XG/500) with additional use of MicroPure imaging for the demonstration and evaluation of microcalcifications. The presence of a focal lesion was verified and microcalcifications were counted at ultrasound and mammography by blinded readers. The sensitivity and specificity were determined, and ROC analysis and AUC analysis were performed.

Results: The women had a median age of 51 years. The average number of microcalcifications detected by sonography (2.12 ± 2.77) and mammography (3.59 ± 6.35) was not significantly different (p > 0.05). Correlation of the techniques was adequate (Pearson’s r = 0.616, p < 0.0001; Spearman‘s rho = 0.654, p < 0.0001). The intraclass correlation coefficient was K = 0.382 ± 0.072 (p < 0.0001), also indicating adequate agreement of both techniques. The sensitivity and specificity were 70 %/30 % for MicroPure and 45 %/55 % for mammography. The positive predictive value of mammography was superior to that of MicroPure (88 % vs. 78 %).

Conclusion: The sonographic detection of microcalcifications with MicroPure imaging in breasts with a hypoechoic focal lesion correlates well with digital mammography.

Zusammenfassung

Ziel: Der Nachweis von Mikrokalk kann mit einem Mammakarzinom assoziiert sein, durch seine breite morphologische Vielfalt korreliert er nur teilweise mit der Dignität der zugrunde liegenden Gewebsveränderung. Ziel der prospektiven Studie war die Vergleichbarkeit von Mikroverkalkungen nach sonografischer Detektion eines echoarmen Herdbefundes mit der Mammografie im dichten Drüsengewebe.

Material und Methoden: 104 Herde mit potentiellen Mikroverkalkungen (82 maligne und 23 benigne Läsionen) wurden in die Studie eingeschlossen. Neben der sonografischen Untersuchung (9 MHz, Aplio XG/500) der Mammaläsion, erfolgte die Mikrokalkdarstellung mittels MicroPure Ultraschallverfahren. Das Vorhandensein einer fokalen Läsion wurde bestimmt und die Mikroverkalkungen wurden für jede Läsion sonografisch und mammografisch ausgezählt und von geblindeten Readern analysiert. Sensitivität, Spezifität, ROC-Analyse und die AUC-Analyse konnten statistisch ausgewertet werden.

Ergebnisse: Das mediane Alter betrug 51 Jahre. Die Zahl der sonografisch (2,12 ± 2,77) und mammografisch (3,59 ± 6,35) erkannten Mikroverkalkungen unterschied sich nicht signifikant (p > 0,05). Die berechneten Korrelationen der Verfahren waren ausreichend gut (Pearson’s r = 0,616, p < 0,0001, Spearman‘s rho = 0,654, p < 0,0001). Der Intraklassen-Korrelationskoeffizient war K = 0,382 ± 0,072 p < 0,0001 und zeigte eine ausreichend gute Übereinstimmung beider Verfahren. Sensitivität und Spezifität waren 70 %/30 % für MicroPure und 45 %/55 % für die Mammografie. In der positiven Vorhersagekraft ist die Mammografie der MicroPure überlegen (88 % vs. 78 %).

Schlussfolgerung: Sonografische Erkennbarkeit von Mikroverkalkungen mit MicroPure, beim Vorliegen eines echoarmen Herdbefundes, korreliert gut mit der digitalen Mammografie.

Key words

microcalcifications - detection of microcalcifications - breast ultrasound - mammography - MicroPure

^* both authors contributed equally to this manuscript

• References

• 1 Sickles EA. Mammographic features of 300 consecutive nonpalpable breast cancers. Am J Roentgenol 1986; 146: 661-663
• 2 Jackson VP. Diagnostic mammography. Radiol Clin North Am 2004; 42: 853-870
• 3 Fischer T, Grigoryev M, Bossenz S et al. Sonographic detection of microcalcifications – potential of new method. Ultraschall in Med 2012; 33: 357-365
• 4 Mostbeck G. Mammasonografie von Mikrokalk – technisch möglich und klinisch relevant?. Ultraschall in Med 2012; 33: 316-319
• 5 Thomas A, Filimonow S, Slowinski T et al. Steigerung der Bildqualität bei der Dignitätsbeurteilung mammasonografischer Herde mittels Frequenz-Compounding. Ultraschall in Med 2007; 28: 387-393
• 6 Teh WL, Wilson AR, Evans AJ et al. Ultrasound guided core biopsy of suspicious mammographic calcifications using high frequency and power Doppler ultrasound. Clin Radiol 2000; 55: 390-394
• 7 Kasumi F. Can microcalcifications located within breast carcinomas be detected by ultrasound imaging?. Ultrasound Med Biol 1988; 14: 175-182
• 8 Okazaki H, Tsujimoto F, Maeda I et al. Radiologic-pathological correlation of punctate hyperechoic foci by ultrasound in stereotactic vacuum-assisted breast biopsy samples. Jpn J Radiol 2009; 27: 438-443
• 9 Gufler H, Buitrago-Téllez CH, Madjar H et al. Ultrasound demonstration of mammographically detected microcalcifications. Acta Radiol 2000; 41: 217-221
• 10 Madjar H, Ohlinger R, Mundinger A et al. BI-RADS-analogue DEGUM criteria for findings in breast ultrasound--consensus of the DEGUM Committee on Breast Ultrasound. Ultraschall in Med 2006; 27: 374-379
• 11 American College of Radiology (ACR). Breast Imaging Reporting and Data Systems (BI-RADS^®). Breast Imaging Atlas. Boston, UA: American of Radiology; 2003
• 12 Balu-Maestro C, Chapellier C, Ben Taaritt I et al. Ultrasound examination of breast microcalcifications: luxury or necessity?. J Radiol 2006; 87: 1849-1858
• 13 Huang CS, Wu CY, Chu JS et al. Microcalcifications of non-palpable breast lesions detected by ultrasonography: correlation with mammography and histopathology. Ultrasound Obstet Gynecol 1999; 13: 431-436
• 14 Soo MS, Baker JA, Rosen EL. Sonographic detection and sonographically guided biopsy of breast microcalcifications. Am J Roentgenol 2003; 180: 941-948
• 15 Yang WT, Suen M, Ahuja A et al. In vivo demonstration of microcalcification in breast cancer using high resolution ultrasound. Br J Radiol 1997; 70: 685-690
• 16 Machado P, Eisenbrey JR, Cavanaugh B et al. New image processing technique for evaluating breast microcalcifications: a comparative study. J Ultrasound Med 2012; 31: 885-893
• 17 Interdisziplinäre S3-Leitlinie für die Diagnostik, Therapie und Nachsorge des Mammakarzinoms. 2012 http://www.awmf.org/uploads/tx_szleitlinien/032-045OL_k_S3__Brustkrebs_Mammakarzinom_Diagnostik_Therapie_Nachsorge_2012-07.pdf
• 18 Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 2002; 225: 165-175
• 19 Sidiropoulos KP, Kostopoulos SA, Glotsos DT et al. Multimodality GPU-based computer-assisted diagnosis of breast cancer using ultrasound and digital mammography images. Int J Comput Assist Radiol Surg 2013; 8: 547-560
• 20 Weigel S, Biesheuvel C, Berkemeyer S et al. Digital mammography screening: how many breast cancers are additionally detected by bilateral ultrasound examination during assessment?. Eur Radiol 2013; 23: 684-691
• 21 Katalinic A. Sinkende Mortalität bei steigender Inzidenz beim Mammakarzinom. Geburtsh Frauenheilk 2009; 69: 237-239
• 22 Kang DK, Jeon GS, Yim H et al. Diagnosis of the intraductal component of invasive breast cancer: assessment with mammography and sonography. J Ultrasound Med 2007; 26: 1587-1600
• 23 Kamiyama N, Okamura Y, Kakee A et al. Investigation of ultrasound image processing to improve perceptibility of microcalcifications. J Med Ultrasonics 2008; 35: 97-105
• 24 Yu PC, Lee YW, Chou FF et al. Clustered microcalcifications of intermediate concern detected on digital mammography: Ultrasound assessment. Breast 2011; 20: 495-500
• 25 Lenz S. Breast ultrasound in office gynecology--ten years of experience. Ultraschall in Med 2011; 32: S3-S7
• 26 Madjar H, Sauerbrei W, Hansen L. Multivariate analysis of flow data in breast lesions and validation in a normal clinical setting. Ultraschall in Med 2011; 32: 511-517
• 27 Földi M, Hanjalic-Beck A, Klar M et al. Video sequence compared to conventional freeze image documentation: a way to improve the sonographic assessment of breast lesions?. Ultraschall in Med 2011; 32: 497-503
• 28 Moon WK, Im JG, Koh YH et al. US of mammographically detected clustered microcalcifications. Radiology 2000; 217: 849-854
• 29 Mansour SM, Adel L. Characterization and guided-procedures of breast suspicious microcalcifications: can MicroPure ultrasound do it?. The Egyptian Journal of Radiology and Nuclear Medicine 2012; 43: 499-505
• 30 Cho N, Moon WK, Cha JH et al. Ultrasound-guided vacuum-assisted biopsy of microcalcifications detected at screening mammography. Acta Radiol 2009; 50: 602-609
• 31 James TA, Harlow S, Sheehey-Jones J et al. Intraoperative ultrasound versus mammographic needle localization for ductal carcinoma in situ. Ann Surg Oncol 2009; 16: 1164-1169
• 32 Eichler C, Hübbel A, Zarghooni V et al. Intraoperative ultrasound: improved resection rates in breast-conserving surgery. Anticancer Res 2012; 32: 1051-1056
• 33 Krekel NM, Haloua MH, Lopes Cardozo AM et al. Intraoperative ultrasound guidance for palpable breast cancer excision (COBALT trial): a multicentre, randomised controlled trial. Lancet Oncol 2013; 14: 48-54