Management of Suspicious Breast Calcifications

Diagnostic Approach

The American Cancer Society recommends stereotactic core needle biopsy as the initial approach for sampling suspicious nonpalpable mammographic abnormalities, particularly calcifications 6, 7
Multiple cores should be obtained during the procedure to ensure adequate sampling of the calcifications, and specimen radiography should be performed to confirm adequate sampling of the microcalcifications 6, 7
The American College of Radiology suggests that not all patients with microcalcifications are ideal candidates for stereotactic biopsy, and factors such as breast size, thickness, and location of the calcifications can affect feasibility 6

If a diagnosis of ductal carcinoma in situ (DCIS) is made by percutaneous core needle biopsy, physicians should be aware that areas of invasive carcinoma will be found in about 20% of cases at the time of surgical excision 7

If the biopsy confirms malignancy, further surgical planning will be required, according to the American Cancer Society 2
A post-biopsy mammogram may be needed to document complete or incomplete removal of calcifications, as recommended by the American College of Radiology 8

The American College of Radiology advises against relying on ultrasound-guided biopsy for calcifications, as it usually cannot be relied upon for biopsy of microcalcifications 6
The National Comprehensive Cancer Network suggests that the mammogram may underestimate the extent of DCIS, particularly with increasing lesion size 3
The American Cancer Society recommends that if invasive disease is found, axillary evaluation may be necessary 8