Consensus Review: A Method of Assessment of Calcifications That Appropriately Undergo a Six-Month Follow-up 1 Cherie M. Kuzmiak, DO, Ria Dancel, MD, Etta Pisano, MD, FACR, Donglin Zeng, PhD, Elodia Cole, MS Marcia A Koomen, MD, Robert McLelland, MD Rationale and Objectives. Breast calcifications seen on mammography may be associated with benign conditions or malig- nancies. Accurate characterization of these calcifications is crucial to providing optimal care that may spare women unnecessary biopsies and appropriately allow interval mammography. The purpose of this study is to determine if consensus characterization of calcifications by two breast imaging experts using standardized criteria can establish that follow-up is a safe option. Materials and Methods. For this retrospective study, our breast imaging database was reviewed and the cases imaged between the years 1999 and 2001 were used to identify patients with calcifications who were recommended for a six-month follow-up or biopsy. All cases had been prospectively assessed by at least two expert breast imagers using standardized features to assess the findings before a recommendation for follow-up or a biopsy was made. A retrospective chart review examining the radiology reports was done to determine the percentage of women from each of the two groups who developed malignancies. Results. Of 744 patients who had mammographically identified clusters of calcifications, 490 clusters (409 single and 81 multi- ple) were diagnosed as probably-benign, and a short-interval 6-month follow-up was recommended. Of these calcifications fol- lowed for three years, only two (0.5%) of the single clusters proved to be malignant, and malignancy was diagnosed at the 12- month follow-up examination. In both cases, the women were diagnosed with ductal carcinoma in situ (DCIS). Of 254 clusters recommended for biopsy, 242 (215 single and 27 multiple) underwent biopsy. A total of 70 cancers were diagnosed: 54 (77.1%) were DCIS and 16 (22.9%) were primary invasive mammary carcinoma (10 cases of invasive ductal carcinoma, 3 cases of inva- sive lobular carcinoma, 2 cases of invasive ductal carcinoma with DCIS, and one case of invasive mucinous carcinoma with DCIS). Twenty-nine percent of women who had a biopsy performed had calcifications associated with malignancy. In contrast, in the women whose calcifications were followed by mammography, only 0.5% went on to develop malignancies. Conclusion. Consensus review of calcifications by two breast imagers using standardized criteria is a safe follow-up option. Key Words. Mammography; Breast Calcifications; Probably Benign; Short-Interval Follow-up © AUR, 2006 Calcium deposits can be found in the breast associated with both benign conditions and with malignancies. Most calcifications are found on routine screening mammo- grams and are characteristically benign in appearance (1). Benign calcifications are usually larger, coarser and have smoother margins compared to malignant calcifications. Malignant calcifications are usually smaller than 1 mm; pleomorphic in size, shape and density; clustered; and may contain branched forms (1–3). Calcifications with ductal carcinoma in situ (DCIS) may also be found in a Acad Radiol 2006; 13:621– 629 1 Dept. of Radiology, University of North Carolina at Chapel Hill, NC Univer- sity of North Carolina School of Medicine, Chapel Hill, NC Lineberger Com- prehensive Cancer Center, Chapel Hill, NC Department of Biostatistics, University of North Carolina at Chapel Hill Address correspondence to Cherie M. Kuzmiak, DO University of North Carolina Department of Radiol- ogy Old Infirmary Building, Room 513 CB #7510 Chapel Hill, NC 27599 Tel: 919-966-4397 Fax: 919-966-0817 E-mail: cherie_kuzmiak@med.unc.edu © AUR, 2006 doi:10.1016/j.acra.2006.01.042 621