Detection of Microcalcifications in Women with Dense Breasts and Hypoechoic Focal Lesions: Comparison of Mammography and Ultrasound

 

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Abstract

Purpose: Microcalcifications in the breasts can point to breast cancer. However, there is great morphologic variety, and microcalcifications do not always correlate with malignancy. We conducted a prospective study to compare ultrasound and mammography in the detection of microcalcifications following sonographic diagnosis of a hypoechoic focal lesion in women with dense breast composition.

Materials and Methods: A total of 104 lesions potentially associated with microcalcifications (82 malignant and 23 benign lesions) were included in the study. The breast was examined by ultrasound (9 MHz, Aplio XG/500) with additional use of MicroPure imaging for the demonstration and evaluation of microcalcifications. The presence of a focal lesion was verified and microcalcifications were counted at ultrasound and mammography by blinded readers. The sensitivity and specificity were determined, and ROC analysis and AUC analysis were performed.

Results: The women had a median age of 51 years. The average number of microcalcifications detected by sonography (2.12 ± 2.77) and mammography (3.59 ± 6.35) was not significantly different (p > 0.05). Correlation of the techniques was adequate (Pearson’s r = 0.616, p < 0.0001; Spearman‘s rho = 0.654, p < 0.0001). The intraclass correlation coefficient was K = 0.382 ± 0.072 (p < 0.0001), also indicating adequate agreement of both techniques. The sensitivity and specificity were 70 %/30 % for MicroPure and 45 %/55 % for mammography. The positive predictive value of mammography was superior to that of MicroPure (88 % vs. 78 %).

Conclusion: The sonographic detection of microcalcifications with MicroPure imaging in breasts with a hypoechoic focal lesion correlates well with digital mammography.

Zusammenfassung

Ziel: Der Nachweis von Mikrokalk kann mit einem Mammakarzinom assoziiert sein, durch seine breite morphologische Vielfalt korreliert er nur teilweise mit der Dignität der zugrunde liegenden Gewebsveränderung. Ziel der prospektiven Studie war die Vergleichbarkeit von Mikroverkalkungen nach sonografischer Detektion eines echoarmen Herdbefundes mit der Mammografie im dichten Drüsengewebe.

Material und Methoden: 104 Herde mit potentiellen Mikroverkalkungen (82 maligne und 23 benigne Läsionen) wurden in die Studie eingeschlossen. Neben der sonografischen Untersuchung (9 MHz, Aplio XG/500) der Mammaläsion, erfolgte die Mikrokalkdarstellung mittels MicroPure Ultraschallverfahren. Das Vorhandensein einer fokalen Läsion wurde bestimmt und die Mikroverkalkungen wurden für jede Läsion sonografisch und mammografisch ausgezählt und von geblindeten Readern analysiert. Sensitivität, Spezifität, ROC-Analyse und die AUC-Analyse konnten statistisch ausgewertet werden.

Ergebnisse: Das mediane Alter betrug 51 Jahre. Die Zahl der sonografisch (2,12 ± 2,77) und mammografisch (3,59 ± 6,35) erkannten Mikroverkalkungen unterschied sich nicht signifikant (p > 0,05). Die berechneten Korrelationen der Verfahren waren ausreichend gut (Pearson’s r = 0,616, p < 0,0001, Spearman‘s rho = 0,654, p < 0,0001). Der Intraklassen-Korrelationskoeffizient war K = 0,382 ± 0,072 p < 0,0001 und zeigte eine ausreichend gute Übereinstimmung beider Verfahren. Sensitivität und Spezifität waren 70 %/30 % für MicroPure und 45 %/55 % für die Mammografie. In der positiven Vorhersagekraft ist die Mammografie der MicroPure überlegen (88 % vs. 78 %).

Schlussfolgerung: Sonografische Erkennbarkeit von Mikroverkalkungen mit MicroPure, beim Vorliegen eines echoarmen Herdbefundes, korreliert gut mit der digitalen Mammografie.

^* both authors contributed equally to this manuscript

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