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Calcifications with suspicious morphology at mammography: should they all be considered with the same clinical significance?

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Abstract
Objectives To evaluate the positive predictive values (PPVs) of calcifications with suspicious morphology by incorporating distribution and clinical factors in two separate cohorts to provide more practical guidance for management.
Methods This retrospective study included 1076 consecutive women from two cohorts (cohort A, 556; cohort B, 520), with calcifications of suspicious morphology seen on mammography that were pathologically confirmed or followed with mammography. Reader-averaged PPVs of the calcifications were analyzed and compared by logistic regression using the generalized estimating equation. Multivariate logistic regression analysis was performed to evaluate independent factors associated with the PPVs of suspicious calcifications.
Results Overall reader-averaged PPVs of suspicious calcifications were 16.8% and 15.2% in cohort A and B, respectively. Reader-averaged PPVs according to morphology in cohort A and B were as follows: amorphous 9.1%, 6.4%; coarse heterogeneous 16.1%, 22.1%; fine pleomorphic 78.8%, 44.7%; and fine linear branching 78.6%, 85.1%, respectively (p < 0.001). PPVs for diffuse amorphous combinations were 2.6% and 2.6%, and for regional amorphous calcifications, 3.6% and 3.1%, respectively. Among diffuse amorphous calcifications, the PPVs for women ≥ 50 years and women without a personal history of breast cancer ranged from 0.0 to 1.9%.
Conclusions Amorphous calcifications have lower reader-averaged PPVs compared to calcifications with other suspicious morphology, falling into the BI-RADS 4a assessment (PPV 2?10%). Amorphous calcifications with diffuse distributions detected in women > 50 years old and without a personal history of breast cancer have reader-averaged PPVs < 2.0%. Further prospective studies are necessary to confirm if these patients can be managed with imaging follow-up.
Author(s)
김은경신희정윤정현이지혜최우정한경화
Issued Date
2021
Type
Article
Keyword
BreasBreast Neoplasms - diagnostic imagingCalcinosis - diagnostic imagingDiagnostic RadiologyFemaleHumansImagingInternal MedicineInterventional RadiologyMammographyMedicineMedicine &amp; Public HealthMiddle AgedNeuroradiologyPredictive Value of TestsProspective StudiesRadiologyRetrospective StudiesUltrasound
DOI
10.1007/s00330-020-07215-8
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7373
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2444877192&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Calcifications%20with%20suspicious%20morphology%20at%20mammography:%20should%20they%20all%20be%20considered%20with%20the%20same%20clinical%20significance%3F&amp;offset=0&amp;pcAvailability=true
Publisher
EUROPEAN RADIOLOGY
Location
EU(유럽연합)
Language
한국어
ISSN
0938-7994
Citation Volume
31
Citation Number
4
Citation Start Page
2529
Citation End Page
2538
Appears in Collections:
Medicine > Medicine
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