DIMA enlargement mammography in microcalcifications: a prospective study with ROC analysis

The purpose of this study was to investigate whether the fourfold magnifica tion mammography (direct magnification, DIMA) technique would perform bette r than conventional 1.5-fold magnification mammography in the differentiati on of breast microcalcifications into benign and malignant. Fifty patients with non-palpable microcalcifications detected by mammography were examined immediately prior to surgical biopsy using both a conventional (1.5-fold) and the DIMA (fourfold) magnification mammography techniques. The microcalc ifications were classified by five experienced radiologists using morpholog ical criteria. A receiver operating characteristics curve (ROC) analysis of the sensitivity and specificity of both techniques in assessing malignancy was then carried out. The DIMA mammography technique was slightly but non-significantly superior to the conventional method in detecting malignancy (p > 0.05). Coarse granu lar and pleomorphic calcifications were detected more frequently with the D IMA technique. Coarse calcifications were significantly more frequently ass ociated with histologically benign findings, whereas fine granular calcific ations were significantly more likely to be malignant lesions. Assessment o f malignancy associated with microcalcifications using morphological criter ia is not significantly improved by mammography techniques with higher magn ification.