Table Of ContentBreast Calcification
A Diagnostic Manual
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Breast Calcification
A Diagnostic Manual
Edited by
Andy Evans
Consultant Radiologist
Breast Services
International Breast Education Centre
City Hospital, Hucknall Road
Nottingham, UK
Ian Ellis
Reader and Consultant in Pathology
Department of Histopathology
City Hospital, Hucknall Road
Nottingham, UK
Sarah Pinder
Senior Lecturer in Histopathology
Department of Histopathology
City Hospital, Hucknall Road
Nottingham, UK
Robin Wilson
Consultant Radiologist
International Breast Education Centre
City Hospital, Hucknall Road
Nottingham, UK
Greenwich Medical Media
4th Floor, 137 Euston Road
London
NW1 2AA
870 Market Street, Ste 720
San Francisco
CA 94109, USA
ISBN number 1841101117
First Published 2002
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permit-
ted under the UK Copyright Designs and Patents Act 1988, this publication may not be reproduced, stored,
or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in
the case of reprographic reproduction only in accordance with the terms of the licences issued by the appro-
priate Reproduction Rights Organisations outside the UK. Enquiries concerning reproduction outside the
terms stated here should be sent to the publishers at the London address printed above.
The rights of Andy Evans, Sarah Pinder, Robin Wilson and Ian Ellis to be identified as editors of this work
have been asserted by them in accordance with the Copyright Designs and Patents Act 1988.
The publisher makes no representation, express or implied, with regard to the accuracy of the information
contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that
may be made.
A catalogue record for this book is available from the British Library.
Distributed worldwide by Plymbridge Distributors Ltd and in the USA by Jamco
Typeset by Phoenix Photosetting, Chatham, Kent
Printed by MPG Books Ltd, Bodmin, Cornwall
Visit our website at
www.greenwich-medical.co.uk
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Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
vii
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ix
Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
xi
1
Benign Breast Calcification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
I Ellis and A Evans
2
Intraductal Epithelial Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
S Pinder and A Evans
3
Invasive Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
53
S Pinder and A Evans
4
Fine Needle Aspiration Cytology and Core Biopsy of . . . . . . . . . . . . . . . . . . . . . .
69
Mammographic Microcalcifications
S Pinder and A Evans
5
Large Bore Biopsy of Breast Calcification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
83
R M Wilson
6
A Practical Approach to the Reporting of Percutaneous . . . . . . . . . . . . . . . . . . . .
99
Sampling of Breast Calcifications
I Ellis and S Pinder
7
A Practical Approach to Radiological Diagnosis of Breast Calcification . . . . . . . .
109
R Wilson and A Evans
8
Localising Breast Calcification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
115
H Burrell
9
Clinical Aspects Diagnosing Microcalcification . . . . . . . . . . . . . . . . . . . . . . . . . . . .
127
D McMillan
10
High Frequency Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
139
W Teh
11
Computer-aided Detection of Mammographic Calcifications . . . . . . . . . . . . . . . .
149
S Astley
12
MRI Detection of DCIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
157
F Gilbert
13
The Nature of Breast Tissue Calcifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
171
K Rodgers and R Lewis
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
191
v
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Preface
vii
Breast calcification seen on mammography
often represents difficult and complex diag-
nostic challenges. Calcifications are more
difficult to detect, analyse and biopsy than
other mammographic abnormalities. There
has been a great deal of research and tech-
nical advances in this area over the last 10
years. Despite this, the value of detecting
breast calcification remains controversial and
the continued subject of debate amongst
breast radiologists, pathologists and clini-
cians.
Current practice means that some women
are harmed by the detection of mammo-
graphic calcification by being subjected to a
variety of investigations ranging from recall
for magnification views to surgical localisa-
tion biopsy for what proves to be benign
disease or normality.
Although current percutaneous biopsy
techniques have reduced the number of
women undergoing surgical biopsy for
benign calcifications, the process of recall,
further views, percutaneous biopsy and
return for results is stressful. Most calcifica-
tions recalled at screening are benign and
their detection and investigation confers no
benefit.
Mammographic calcification is, however,
an important feature of invasive and in situ
breast cancer. Its detection enables the
diagnosis of high-grade invasive cancer at
small sizes when the prognosis is good. The
detection of high-grade DCIS prevents the
development of high-grade invasive breast
cancer and so saves lives. The value of
diagnosing low-grade DCIS is less clear as a
significant proportion of these lesions would
never have become invasive in the woman’s
lifetime.
This book brings together in one volume,
current thinking on the detection and diag-
nosis of breast calcification. Current issues
such as computer-aided detection, choice of
biopsy technique, assessing adequacy of per-
cutaneous biopsy, predicting and diagnosing
invasion will be addressed as well as more
novel approaches and ideas, such as the use
of synchrotron radiation for diagnosis and
the use of mammographic calcification as a
prognostic factor.
We hope this book will help those
involved in managing women with breast
calcification to re-evaluate their own meth-
ods of detection and diagnosis, the value of
detecting such calcification and where the
future lies in this fascinating field.
Andy Evans May 2002
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Sue Astley
Imaging Science and Biomedical
Engineering
University of Manchester
Stopford Building
Oxford Road
Manchester, UK
Helen Burrell
Department of Radiology
Breast Screening Unit
City Hospital
Hucknall Road
Nottingham, UK
Fiona Gilbert
Academic Department of Radiology
University of Aberdeen
West Block, Polwarth Building
Foresterhill
Aberdeen, UK
Robert A Lewis
School of Physics and Materials Engineering
Monash University
Victoria
Australia
Douglas McMillan
Professorial Unit of Surgery
City Hospital
Hucknall Road
Nottingham, UK
Keith D Rodgers
Department of Materials and Medical
Services
Cranfield University
Shrivenham
Swindon
Wiltshire , UK
Will L Teh
Department of Radiology
Northwick Park and St Marks Hospital
Watford Road
Harrow, UK
ix
Contributors
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