Evaluation of breast microcalcifications

As screening mammography has become more widespread, the urgency to provide more sensitive and more specific interpretations has also increased. Although many calcifications detected on mammograms are characteristically benign and need no further evaluation, there are many microcalcifications that warrant further evaluation with special views. The importance of their detection lies in the fact that many malignancies are mammographically manifested solely as microcalcifications. Once detected, radiologists have attempted to characterize and stratify microcalcifications by their level of suspicion to improve the predictive value of biopsy recommendations as depicted in Table 1. This is an important endeavor because the cost to society, especially in this era of limited resources, and the collective anxiety produced by benign breast biopsies are both great. When a biopsy is recommended, the breast team, which includes the surgeon, radiologist, and pathologist should ensure that histopathologic correlation is achieved. By participating in this process, keeping track of the results of biopsies generated from our practices, and learning from our colleagues, we can fine tune our interpretive skills. Communication among us and our colleagues from other specialties should be encouraged and can be fostered by the use of the BI-RADS lexicon.