Journal of Clinical Pathology 2008;61:145-151
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Calcification in breast lesions: pathologists’ perspective
1 Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong
2 Department of Pathology, Singapore General Hospital, Singapore
3 Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong
4 Department of Radiology, North District Hospital, Hong Kong
5 Department of Radiology, International Islamic University, Kuantan, Malaysia
Correspondence to:
Dr Gary M Tse, Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Ngan Shing Street, Shatin, NT, Hong Kong SAR; garytse{at}cuhk.edu.hk
Evaluation of calcification in breast lesions is a major assessment criterion for breast mammography. The morphology and distribution of the calcification are related to the histology of the lesions. Radiologically, calcifications can be divided into: benign; intermediate concern; and higher probability of malignancy according to the morphology. Different pathological entities may give rise to different calcifications. Fibrocystic changes may give rise to milk of calcium or teacup type calcification, or small calcifications occurring in a cluster. Fibroadenoma may be associated with large popcorn like calcifications, and sclerosing adenosis may have fine, punctate or granular calcifications. Fat necrosis may give rise to egg shell calcification. Precursor malignant lesions give rise to benign to indeterminate type calcifications, and may occasionally be associated with malignant type calcifications. For malignant lesions, ductal carcinoma in situ and invasive duct carcinoma may be associated with large irregular, rod or V shaped, pleomorphic or branching type calcifications that follow the distribution of the duct. Furthermore, analysis of the characteristics of the calcifications may help to predict the tumour size and grade, and presence of invasion.
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