(Ultrasound Review) Microcalcifications demonstrated with ultrasound imaging could be successfully biopsied with sonographic guidance, according to researchers at Duke University Medical Center. Due to improvements in technology, now microcalcifications are more frequently visible with high-resolution ultrasound sonography.
"These microcalcifications are usually identified with hypoechoic masses that facilitate detection of the echogenic microcalfications," the authors reported.
When compared with stereotactic biopsy, ultrasound has certain advantages. There is no ionizing radiation involved; there is no compression of the breast; the patient positioning is more comfortable; and ultrasound guidance is faster and easier for the radiologist.
The study involved 23 patients that had microcalcifications detected on mammography. Initially 38 lesions were considered, but 40% showed no abnormality, uncertain findings or no microcalcifications on ultrasound imaging.
"Two groups of lesions were evaluated: microcalcifications within an associated mass or area of architectural distortion; and large clusters of microcalcifications with a diameter of 1 cm or greater containing numerous pleomorphic microcalcifications without an associated mammographic abnormality other than fibroglandular density," they wrote. The majority of lesions showed at least 15 pleomorphic microcalcifications at mammography, they said.
Patients either underwent percutaneous core biopsy with an automated gun and 14-gauge needle (69%) or 11-gauge vacuum-assisted technique (9%), or needle localization with surgical excision (22%). The authors reported "all 23 lesions were successfully biopsied under sonographic guidance with microcalcifications seen on specimen radiographs in each case." Further core biopsy and mammographic assessment of core was performed when no microcalcifications were shown on the first mammographic evaluation of the cores taken.
Pathological evaluation of malignant lesions showed ductal carcinoma in situ or invasive ductal carinoma, or both. They reported one benign lesion with microcalcifications that was a radial scar and ultrasound showed a dilated duct with echogenic foci. The authors suggested that further study is warranted to establish how sonographically guided evaluation of microcalcifications compares with stereotactic core biopsy.
"Sonographically guided biopsy of suspicious microcalcifications of the breast: a pilot study"M Soo et al
Department of radiology, breast imaging division, Duke University Medical Center, Durham, NC AJR 2002 April; 178:1007-1015
By Ultrasound Review
June 27, 2002
Copyright © 2002 AuntMinnie.com
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![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
