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Microcalcifications

Author: Hind Warzecha, M.D.

Last author update: 1 June 2010

Last staff update: 26 August 2020

Copyright: 2002-2023, PathologyOutlines.com, Inc.

PubMed Search: Microcalcifications in breast [title]

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Table of Contents

Cite this page: Warzecha H. Microcalcifications. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/breastcalcification.html. Accessed June 2nd, 2023.

Definition / general

Deposits of calcium in breast tissue visible on mammographic imaging

Terminology

Microcalcifications are either calcium phosphate (basophilic, nonbirefringent) or calcium oxalate (seen with polarized microscopy, not H&E, Am J Surg Pathol 1990;14:961, Arch Pathol Lab Med 1989;113:1367, Mod Pathol 1992;5:146)

Epidemiology

Can occur at any age but more common after menopause

Etiology

Can be associated with both benign and malignant lesions

Clinical features

Presence of microcalcifications on mammography has led to detection of breast tumors as small as 1 - 2 mm
Microcalcifications are present in 50% of carcinomas versus 20% of benign breast disease but only 20% of "suspicious" microcalcifications are actually part of a malignant process

Radiology description

Suspicious microcalcifications are irregular and fine; nonsuspicious are coarse and chunky
Pathologists must detect microcalcifications in glass slides that correspond to those in radiographs - if not present, submit additional tissue, obtain additional levels or use polarized microscopy to look for calcium oxalate (Pathologica 2007;99:5)
Exhaustive searching for microcalcifications yields a small increase in specific diagnostic information but with a high technical cost (Mod Pathol 2001;14:350)
Note: microcalcifications may be missing from biopsy due to retrieval failure (Radiology 2006;239:61)
Note: recommended to examine all vacuum assisted breast biopsy specimens histologically, even those without microcalcifications (Eur Radiol 2008;18:925)
Detection of calcium phosphate microcalcifications is reduced with glyoxal fixative (Hum Pathol 2004;35:1058)

Radiologic BI-RADS (Breast Imaging Reporting and Data System of American College of Radiology) classification:

Category 0 - need additional imaging evaluation
Category 1 - negative
Category 2 - benign finding
Category 3 - probably benign finding - short term interval follow up suggested
Category 4 - suspicious abnormality - biopsy should be considered
Category 5 - highly suggestive of malignancy - appropriate action should be taken
References: American College of Radiology: ACR BI-RADS® Atlas, Fifth Edition, 2013
Suggested that radiologists subcategorize BI-RADS 4 as 4A (low suspicion for malignancy), 4B (intermediate suspicion of malignancy) and 4C (moderate concern but not classic for malignancy, Breast J 2010;16:28)

LeGal classification of microcalcifications

Type 1 - annular
Type 2 - regularly punctiform
Type 3 - too fine for precizing the shape
Type 4 - irregularly punctiform
Type 5 - vermicular (Bull Cancer 1984;71:57)

Radiology images

Images hosted on other servers:

DCIS

Case reports

61 year old woman with suspicious mammographic calcifications (Case of the Week #25)
Gold salts within intramammary nodes may simulate microcalcifications (Hum Pathol 1988;19:992)

Microscopic (histologic) description

Calcium phosphate microcalcifications are associated with benign and malignant disease; are blue / purple psammoma like chunks
Calcium oxalate crystals are typically within benign cysts or terminal ductules that are histologically apocrine or GCDFP-15 positive; are associated with LCIS but only rarely with invasive carcinoma (Am J Surg Pathol 1991;15:586)
Calcium oxalate crystals may be present in centrifuged fixative (Am J Surg Pathol 1997;21:255)

Microscopic (histologic) images

AFIP images

Calcium oxalate calcifications