What can a calcification be
Artifact, benign or suspicious
Artifact
What materials can be artifacts/ mimic calcifications and how can you identify each of them
- Deodorant: high density in axilla, doesn’t change position on different views inferring that it’s on the image receptor
- Zinc oxide: collects on moles. It should disappear on follow up
- Metallic artifact from electrocautery can leave small fragments; found next to scar tissue and is denser than calcium
Which two calc distributions are most concerning for ca
Segmental > Linear (pic 473)
segmental> linear> grouped> regional> scattered
SLGRS
She loves going round sand (think beach trips)
What types of benign calcifications are there
see 473
Dermal Vascular Popcorn Secretory (Rod like) Egg shell Dystrophic Round
Think:
Popcorn looks round and dystrophic
Egg shells are dermal layers
Vascular/ Vessels secrete blood
Features of dermal calcifications
Dermal:
- Found in sweaty areas (axilla, cleavage, folds)
- Often grouped together like a paw
- They stay in the same place on CC and MLO views*** tattoo sign
- When asked for confirmation: get a tangential view
Features of vascular calcifications
Vascular:
Parallel, linear calcifications. Usually obvious
Popcorn is a buzzword for
degenerating fibroadenoma;
they typically begin around the periphery and slowly coalesce over subsequent images
Features of Secretory rod like calcifications and its buzzword
- These are big, easily seen, point towards the nipple
- Typically bilateral
- Buzzword: cigar shaped with a lucent center or dashes but no dots
- buzz age 10-20 years after menopause; THEY CANNOT HAPPEN IN PRE-MENOPAUSAL WOMEN. They only occur when the duct involutes. ( My thoughts - not in the book- young girls with premature ovarian failure basically have an early menopause)
Features of egg shell calcifications and its buzzword
Fat necrosis that results from trauma (surgical or accidental)
Liponecrosis macrocystica: if massive - latin words are popular on exam
Buzz word: lucent centered ( recall secretory rod like are cigar shaped with lucent center)
Features of dystrophic calcifications and its buzzword
Result from radiation, trauma or surgery. These are BIG.
Buzz word “irregular shape”
can also have lucent center ( recall secretory rod like are cigar shaped with lucent center and egg shell buzz word is lucent center)
Differentiate btw secretory rod like, egg shell and dystrophic calcs.
see 474 or other flashcards.
Features of round calcifications and its buzzword
- Scattered, BL, benign
- usually due to fibrocystic changes
- If clustered by themselves or are new they may need workup just like a mass
- if seen on the first mammo you can BR-3 them
You see powdery spread out calcs on CC which layer on MLO and appear linear on ML with a curved bottom like a hemisphere. What is it and what is it due to and how can it be seen?
Milk of calcium; See 475 pics
Forms due to fluid filled in a lobule due to fibrocystic changes
Can only be seen with polarized light to assess birefringence
What types of suspicious calcifications are there
- Amorphous
- Coarse heterogenous
- Fine pleomorphic
- Fine linear/ fine linear branching
- Calc assoc with focal asymmetry/mass
Amorphous
good table on 476 for ddx
looks like powdered sugar, cant be counted.
Distribution is key:
- Segmental is suspicious
- BL and scattered is benign
DDx:
- Fibrocytic change (most likely)
- DCIS (LOW GRADE)
- sclerosing adenosis or columnar cell change
Coarse heterogeneous
good table on 476 for ddx
- Countable
- with dull tips, they cant poke you (think of coarse salt)
- larger than 0.5 mm
- can be assoc with a mass (fibroadenoma or papilloma)
DDx:
- DCIS (low intermediate grade)
- Fibrocystic change
- papilloma/ fibroadenoma
Fine pleomorphic
good table on 476 for ddx
- countable
- sharp tips- would poke you
- smaller than 0.5 mm
- SECOND HIGHEST LIKELIHOOD of malignancy
DDx:
- DCIS (high grade)
- Fibrocystic change
- Papilloma/ fibroadenoma (less likely)
Fine linear / fine linear branching
- this distribution makes fine pleomorphic calcifications more suspicious
DDx basically is DCIS (mimics ductal proliferation)/ atypical look for secretory or vascular calcs.
HIGHEST likelihood of malignancy
Which calcs have the highest and second highest rate of malignancy
Fine linear/ fine linear branching»_space;> Fine pleomorphic
In answer choices pick fine linear branching over fine pleomorphic if both given as options, otherwise pick fine pleomorphic if fine branching is NOT an option.
Whats a puff of smoke or warning sign
Seeing increased tissue density around suspicious calcifications as chance of cancer goes up.
US is useful for extent of disease
If you see only pure calcifications should you get an US?
No unless if assoc with:
- Palpable mass
- visualized mass
