Background: Breast microcalcifications have been extensively described for many years with robust data regarding the positive predictive value of malignancy. Despite the vast literature, there are occasional look-alike breast calcifications that can confuse the radiologist. Typical benign calcifications include large rod-like, round, dystrophic, rim, vascular, and milk of calcium (among others). These have characteristic appearances and when seen on screening mammography they require no further evaluation. However, during the development and progressive formation of these calcifications, they may demonstrate features that mimic malignancy. Amorphous, fine pleomorphic, fine linear/fine linear branching, and coarse heterogeneous calcifications are suspicious morphologies. While calcifications with these features are typically recommended for biopsy, they occasionally mimic benign lesions and cause stumbling blocks for the interpreting radiologist.
Learning Objectives: • To review the benign microcalcification morphologies that can occasionally mimic malignancy • Review the malignant microcalcification morphologies that can present with benign characteristics. • Provide tools for the radiologist to discern between doppelgänger microcalcifications.
Abstract Content/Results: This exhibit will present benign microcalcifications, including rim, vascular, large rod-like, dystrophic, and popcorn. The standard, typical imaging appearances will be presented followed by five cases of similar-appearing morphologies. The diagnosis will then be given along with tips on discerning the benign from the malignant. In a similar manner, malignant microcalcifications will be presented including amorphous, coarse heterogeneous, fine pleomorphic, and fine linear/fine linear branching to include the typical imaging appearance. Five cases of similar-appearing morphologies will be shown followed by the diagnosis with tips on lesion differentiation.
Conclusion: While there may be features of both benign and malignant microcalcifications that can cause confusion, there are evidence-based safe management recommendations supported by literature. Some subtle features of these doppelgänger microcalcifications can also aid in differentiating the malignant from benign.
