BREAST CALCIFICATION WORK UP:
-When you look to a mammography film containing calcification, the first sign to be observed is if this calcification diffuse or regional.
-If it is diffuse, and whether this calcification is covering the whole breast or seen as multiple similar clusters, both appearances are considered to be benign calcification with BI RADS category 2.
-If it is regional, the second sign to be evaluated is whether this calcification with no ductal distribution or with ductal distribution.
-If there is no ductal distribution , look to the size of this calcification.
-If the size of calcification is more than 0.5mm looks to the shape of this calcification.
-If it is rounded, coarse and with smooth borders, it is considered to be ROUND CALCIFICATION which is of benign nature with BI RADS categories 2.
-If it is with irregular shape and size, it is considered to be coarse, heterogeneous calcification which is of suspicious nature with BI RADS category 4.
-I f the size is less than 0.5mm, look to the shape whether it is round or flakes and small in size with hazy appearance or thin linear or curvilinear with discontinuity.
-If it is the former, this called amorphous calcification, which could be bilateral and diffuse with category 2, or bilateral and clusters with category 3, or unilateral with clusters, or new lesion in follow up, or with contra lateral cancer, the latter three should be considered BI RADS category 4(suspicious).
-When you look to a mammography film containing calcification, the first sign to be observed is if this calcification diffuse or regional.
-If it is diffuse, and whether this calcification is covering the whole breast or seen as multiple similar clusters, both appearances are considered to be benign calcification with BI RADS category 2.
-If it is regional, the second sign to be evaluated is whether this calcification with no ductal distribution or with ductal distribution.
-If there is no ductal distribution , look to the size of this calcification.
-If the size of calcification is more than 0.5mm looks to the shape of this calcification.
-If it is rounded, coarse and with smooth borders, it is considered to be ROUND CALCIFICATION which is of benign nature with BI RADS categories 2.
-If it is with irregular shape and size, it is considered to be coarse, heterogeneous calcification which is of suspicious nature with BI RADS category 4.
-I f the size is less than 0.5mm, look to the shape whether it is round or flakes and small in size with hazy appearance or thin linear or curvilinear with discontinuity.
-If it is the former, this called amorphous calcification, which could be bilateral and diffuse with category 2, or bilateral and clusters with category 3, or unilateral with clusters, or new lesion in follow up, or with contra lateral cancer, the latter three should be considered BI RADS category 4(suspicious).
-If it is less than 0.5 with variable size and shape could be pleomorphic calcification which is more cancerous than amorphous one,if it is in linear distribution,it is considered to be category 5,and if it is in a segmental distribution considered to be in category 4.Usually amorphous and pleomorphic could be seen together.
-If it is linear or curvi linear with discontinuity, this should be considered as calcification with high probability of malignancies with BI RADS category 5.
-Also, if the size is less than 0.5mm with the volume of breast tissue affected more than 2cc this will be considered benign calcification with BI RADS category 2.
- Also, if the size is less than 0.5mm with cluster of calcification contain at least 5 points of calcification in a small volume of breast tissue less than 1cc, this will be considered suspicious with category 4.
-Finally, if the calcification showed ductal distribution in the form of segmental, ducts or branches of ducts or segmental or lobar, this should be considered suspicious with category 4.If it is with ductal calcification with linear pattern this should be considered as high probability of malignancies with category 5.
CONCLUSION:
-Look to the calcification, and then answer the following questions
-Is it diffuse or regional?
-If it is diffuse, considered it benign entity with BI RADS category 2
-If it is regional, look to the configuration of calcification, whether it is of ductal or no ductal distribution.
-If it is of no ductal distribution, look to the size of the lesion, if it is more than or less than 0.5mm.
-If it is more than 0.5mm, it will be either round calcification with category 2 or coarse and heterogeneous calcification with category 4, this depend on the shape of these calcification.
-If it is less than 0.5mm, it will be either amorphous calcification with different categories according to their distributions, or thin linear or curvilinear calcification which is categorized as 5.
-If it is of ductal distribution, it could be either of curvilinear shape(category 5) or other shape rather than curvilinear with segmental distribution, lobar distribution which could be categorized as 4(suspicious).
-If it is linear or curvi linear with discontinuity, this should be considered as calcification with high probability of malignancies with BI RADS category 5.
-Also, if the size is less than 0.5mm with the volume of breast tissue affected more than 2cc this will be considered benign calcification with BI RADS category 2.
- Also, if the size is less than 0.5mm with cluster of calcification contain at least 5 points of calcification in a small volume of breast tissue less than 1cc, this will be considered suspicious with category 4.
-Finally, if the calcification showed ductal distribution in the form of segmental, ducts or branches of ducts or segmental or lobar, this should be considered suspicious with category 4.If it is with ductal calcification with linear pattern this should be considered as high probability of malignancies with category 5.
CONCLUSION:
-Look to the calcification, and then answer the following questions
-Is it diffuse or regional?
-If it is diffuse, considered it benign entity with BI RADS category 2
-If it is regional, look to the configuration of calcification, whether it is of ductal or no ductal distribution.
-If it is of no ductal distribution, look to the size of the lesion, if it is more than or less than 0.5mm.
-If it is more than 0.5mm, it will be either round calcification with category 2 or coarse and heterogeneous calcification with category 4, this depend on the shape of these calcification.
-If it is less than 0.5mm, it will be either amorphous calcification with different categories according to their distributions, or thin linear or curvilinear calcification which is categorized as 5.
-If it is of ductal distribution, it could be either of curvilinear shape(category 5) or other shape rather than curvilinear with segmental distribution, lobar distribution which could be categorized as 4(suspicious).
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