Variable Appearances of Ductal Carcinoma In Situ Calcifications on Digital Mammography, Synthesized Mammography, and Tomosynthesis: A Pictorial Essay

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Variable Appearances of Ductal Carcinoma In Situ Calcifications on Digital Mammography, Synthesized Mammography, and Tomosynthesis: A Pictorial Essay Esther Hwang, MD, Janet Szabo, MD, Emily B. Sonnenblick, MD, Laurie R. Margolies, MD Canadian Association of Radiologists Journal Volume 69, Issue 1, Pages 2-9 (February 2018) DOI: 10.1016/j.carj.2017.04.005 Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

Figure 1 A 44-year-old woman presented for screening with no personal or family history of breast cancer. A diagnostic exam was performed for additional images. Two groups of microcalcifications were identified in the right breast, 1 of which was fine pleomorphic calcifications in the right upper quadrant, 8.5 cm from the nipple. Synthesized mammography (SM) demonstrates fewer but sharper calcifications compared with full-field digital mammography (FFDM). (A) Right craniocaudal views of FFDM, SM, and digital breast tomosynthesis (left to right). (B) Right mediolateral oblique views of FFDM, SM, and digital breast tomosynthesis. (C) Stereotactic core biopsy yielded intermediate to high-grade ductal carcinoma in situ with comedonecrosis. Canadian Association of Radiologists Journal 2018 69, 2-9DOI: (10.1016/j.carj.2017.04.005) Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

Figure 2 A second group of fine pleomorphic calcifications in the right upper quadrant, 9.5 cm from the nipple, in the patient mentioned in Figure 1 with multifocal ductal carcinoma in situ. The greatest number and contrast of calcifications are seen on full-field digital mammography (FFDM). Calcifications are barely visible on synthesized mammography (SM) and digital breast tomosynthesis (DBT). (A) Right craniocaudal views of FFDM, SM, and DBT (left to right). (B) Right mediolateral oblique views of FFDM, SM, and DBT. (C) Stereotactic core biopsy yielded intermediate to high-grade ductal carcinoma in situ with comedonecrosis. Canadian Association of Radiologists Journal 2018 69, 2-9DOI: (10.1016/j.carj.2017.04.005) Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

Figure 3 A 55-year-old woman presented with a palpable abnormality in her left breast. She had no personal or family history of breast cancer and had a history of a benign right breast biopsy. The patient had indwelling silicone implants. In the left upper inner quadrant, there are pleomorphic calcifications extending anteriorly from the implant extending craniocaudally to the nipple (not the palpable region). On both craniocaudal (CC) and mediolateral oblique views, the greatest number and conspicuity of calcifications are demonstrated on full-field digital mammography (FFDM). Linear branching pattern is apparent on the CC view. (A) Left CC views of FFDM, synthesized mammography, and digital breast tomosynthesis (left to right). (B) Left mediolateral oblique views of FFDM, synthesized mammography, and digital breast tomosynthesis. (C) Stereotactic core biopsy yielded high-grade ductal carcinoma in situ. Canadian Association of Radiologists Journal 2018 69, 2-9DOI: (10.1016/j.carj.2017.04.005) Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

Figure 4 A 44-year-old woman presented for screening. She had no personal or family history of breast cancer. In the upper outer quadrant of the left breast, 8 cm from the nipple, there was an 8 mm mass containing round calcifications. On the craniocaudal view, full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) demonstrate few, indistinct calcifications whereas synthesized mammography (SM) demonstrates the greatest number and conspicuity of calcifications. On the mediolateral oblique view, FFDM demonstrates the greatest number of calcifications, whereas SM and DBT demonstrate fewer calcifications but with greater contrast. (A) Left craniocaudal views of FFDM, SM, and DBT (left to right). (B) Left mediolateral oblique views of FFDM, SM, and DBT. (C) Ultrasound guided biopsy yielded high-grade ductal carcinoma in situ. Canadian Association of Radiologists Journal 2018 69, 2-9DOI: (10.1016/j.carj.2017.04.005) Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

Figure 5 A 58-year-old woman presented with left-sided bloody nipple discharge. In the left lower inner quadrant, there were new clustered pleomorphic microcalcifications spanning 8 mm at the 7:00 axis, 5 cm from the nipple. The greatest number of calcifications is seen on full-field digital mammography (FFDM) on the craniocaudal view, but with poor contrast. In the mediolateral oblique view, calcifications are greatest in number and conspicuity on synthesized mammography (SM) and not visible at all on digital breast tomosynthesis (DBT). (A) Left craniocaudal views of FFDM, SM, and DBT (left to right). (B) Left mediolateral oblique views of FFDM, SM, and DBT. (C) Stereotactic-guided biopsy yielded high-grade ductal carcinoma in situ. Canadian Association of Radiologists Journal 2018 69, 2-9DOI: (10.1016/j.carj.2017.04.005) Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

Figure 6 A 66-year-old woman with a remote history of right-sided breast cancer status postchemotherapy and lumpectomy presented for diagnostic mammogram. There was no family history of breast cancer. At the right 9:00 axis, 6 cm from the nipple, there are calcifications posteriorly. Although the calcifications are clearly demonstrated on all 3 imaging types, number, conspicuity, and linear orientation are greatest on synthesized mammography (SM). (A) Right craniocaudal views of full-field digital mammography, SM, and digital breast tomosynthesis (left to right). (B) Right mediolateral oblique views of full-field digital mammography, SM, and digital breast tomosynthesis. (C) Stereotactic core biopsy yielded high-grade ductal carcinoma in situ. Canadian Association of Radiologists Journal 2018 69, 2-9DOI: (10.1016/j.carj.2017.04.005) Copyright © 2017 Canadian Association of Radiologists Terms and Conditions