Microcalcifications of non-palpable breast lesions detected by ultrasonography: correlation with mammography and histopathology

Objectives Microcalcifications are generally not demonstrated well on ultra sonography. In this study, we attempted to demonstrate the usefulness of hi gh-resolution ultrasonography in the detection of microcalcifications assoc iated with non-palpable breast cancers. Design Fourteen patients with non-palpable breast lesions in whom microcalc ifications were detected or suspected by ultrasonography and one patient in whom microcalcifications were detected on mammography only were included i n the study. Mammography and analysis of biopsy specimens were performed in each patient and the findings were correlated with the ultrasonographic fi ndings. Ultrasonography and mammography were performed independently by dif ferent physicians at different times. Results In three patients less than or equal to 30 years of age, who were n ot at high risk of breast cancer and who had no evidence of cancer on palpa tion, high-resolution ultrasonography clearly showed microcalcifications bu t no mass. Two of these patients had ductal carcinoma in situ and one had s mall invasive carcinoma with extensive comedocarcinoma. Among the other 12 patients with non-palpable breast lesions, ultrasonography detected microca lcifications accurately in six and suggested possible microcalcifications i n a further four Microcalcifications in all of these ten patients were conf irmed by mammography thereafter. Four of these ten patients had ductal carc inoma in situ, with or without invasive carcinoma. Of the remaining two pat ients, one demonstrated false-positive findings and one false-negative find ings on ultrasound. On high-resolution ultrasonography, microcalcifications produced the appearance of twinkling stars (bright dots in different plane s) in a dark sky (contrasted against ill-defined hypoechoic patches), corre sponding on histopathology to groups of expanded ducts with increased cell density with or without necrosis. Conclusion High-resolution ultrasonography may be used for detection of mic rocalcifications in non-palpable breast lesions. Ultrasonography is helpful in screening for early breast cancers, especially in young patients who ar e at risk for breast cancer and in whom mammography is not usually carried out.