Is there any relevance in segregating intracellular versus extracellular calcium in this situation?
Microcalcifications are a common finding in mammograms. They are of concern when they are clustered and of variable shapes and sizes (pleomorphic). The work-up includes diagnostic mammograms and targeted ultrasound if there is concern regarding an associated mass. If found to be suspicious, the area of calcifications are best biopsied through a stereotactic approach or ultrasound, if there is an associated mass. Open surgical biopsy as a primary approach is discouraged as even suspicious micro calcifications end up with a cancer diagnosis only 30-40% of the time. Multiple publications have shown primary open surgical biopsy to be more expensive, more morbid in terms of infection and hematoma rates, deformity of the breast and higher positive margin rates. In addition, pre-surgery image guided core biopsy allows the surgeon to do a single operation of partial mastectomy and sentinel lymph node biopsy if the stereotactic or ultrasound biopsy shows an invasive breast cancer. The case is so strong for image-guided stereo or ultrasound biopsy is so strong that the NAPBC and NQMBC count it as a quality indicator.
Thank you for your informed response. Why would "clustering" or "shape" (pleiomorphism) raise concern?
For radiologists, the significance of microcacifications in the breast is to help in detecting cancer. Not all calcifications are due to cancer, but shape and destribution can aid in selecting those patients who will require biopsy to rule out breast cancer.
microcalcifications are associated both with early stage breast cancer (CA in situ) and more advanced cancers. Absence of microcalcifications di not rule out breast CA as there are other signs.
Best way of detecting microcalcificatikns is mammography.
Dr Taif, If the imaging does not allow one to distinuish between intracellular calcxium and extracellular calcium, could the calcium seen on imaging, particularly in breast tissue, be a reflection of cell death?