Mammogram reports often show breast calcifications, so many patients often ask the following questions: Is calcification in the breast a sign of breast cancer? What kind of calcification indicates the possibility of breast cancer? Why is calcification found in mammogram but no abnormality in ultrasound? The following is a general knowledge to help you understand what calcification in the breast is all about: Is calcification in the breast breast cancer? No, most of the breast calcifications seen in clinical practice are actually benign calcifications. Most of the calcifications seen clinically are actually benign calcifications. Calcifications in the breast can be classified into benign and malignant calcifications depending on their shape, size and degree of aggregation. A formal mammogram report should state the BI-RADS classification of the calcifications, with grades 1-3 being benign and grades 4 and above having the potential for malignancy. Polymorphic and heterogeneous calcifications (granular punctate calcifications): more suspicious than indeterminate calcifications, they vary in size and shape; often less than 0.5 mm in diameter. Linear or linear branching calcifications (cast calcifications): thin, irregular linear calcifications, often discontinuous, less than 0.5 mm in diameter, these signs suggest that the calcifications are formed in the lumen of the duct invaded by breast cancer. These signs suggest that the calcifications are formed in the ductal lumen invaded by breast cancer. Cluster-like microcalcifications: They are often the only X-ray signs of early breast cancer. The nature and extent of the lesion can be reflected by the morphology, size, number and density of the microcalcifications. Microcalcifications may be located in or around the lump, with a total number of 6-15, with uneven density and varying size. When encountering a larger number of calcifications, it is not the number of calcifications but the morphology of each calcification that is important. How do calcifications in the breast form? The occurrence of intra-mammary calcifications is associated with cellular degeneration within the lesion, calcium salt deposition following necrosis, paracrine secretion of tumor cells and mammary cells, and other factors. The occurrence of intra-mammary calcification in non-lesional breast tissue is related to factors such as local inflammatory damage to the tissue and calcium salt deposition after repair of the damage. What kind of calcification is relevant for the diagnosis of early breast cancer Intra-mammary calcification is divided into coarse calcification (diameter >0.5 mm) and microcalcifications (diameter <0.5 mm)< span="">; microcalcifications can be divided into microcalcifications outside the mass and microcalcifications within the mass and microcalcifications within the ducts according to the location of the calcification. Coarse calcifications within or around the mass are usually seen in benign breast disease. Isolated coarse calcifications within the breast are commonly seen as calcium salt deposits following tissue injury and local necrosis. In contrast, the identification of microcalcifications, especially the presence or absence of microcalcifications within the mass or lesion, is important in the diagnosis of breast cancer, especially ductal carcinoma in situ. Why is microcalcification found on mammography but not on ultrasound? High-frequency digital mammography is the most advantageous for the detection of calcifications, with over 95% identification of microcalcifications and a high detection rate for large and fatty breasts, detecting 85-90% of breast cancers over the age of 50 and detecting breast cancers that are negative to clinical palpation. It has high sensitivity and specificity for in situ intraductal carcinoma with calcification as the main manifestation. High-frequency digital mammography has greatly improved the early detection rate of breast cancer. Computer-aided detection of microcalcifications on mammography images has become a hot topic of research for early diagnosis of breast cancer. This is mainly because small, granular clusters of microcalcifications are an important early sign of breast cancer, and often the only sign. However, mammography can easily miss small cancer foci close to the chest wall and dense breast. With the improvement of ultrasound instrument performance and the application of high-frequency probes, microcalcifications can be observed with ultrasound technology. Ultrasound can detect small beads of 110 μm in a hypoechoic background simulating breast cancer, with a detection rate of 56% for microcalcifications within the mass. However, breast glandular echogenicity is very complex and most of the breast glandular tissue is hyperechoic. It is difficult to identify microcalcifications in the breast that are also hyperechoic in a hyperechoic background, and because breast ultrasound is a real-time dynamic scanning method of sectioning, the scanning process is heavily dependent on the sonographer’s scanning technique and clinical experience. Are all the dotted hyperechoes in the breast detected by ultrasound microcalcifications? Ultrasound is increasingly being used to scan for microscopic lesions in the breast, but punctate hyperechoes found in the breast are not always microscopic calcifications; they are not due to density, but rather to the presence of an ultrasound interface. Artifacts. Clusters of dotted hyperechoes in the soft tissues of the breast rather than within the mass, as well as dotted hyperechoes within hypoechoic masses, need to be carefully screened for true calcifications. Screening is also sometimes necessary when there are clusters of strong echogenicity in the breast with posterior acoustic shadowing. What should I do if I encounter calcification? Diffuse or scattered punctate calcifications (randomly scattered distribution) —– Follow up review (benign) Coarse masses of calcifications or isolated clusters of calcifications in the breast —– Follow up (benign) Cluster calcifications (clusters of calcifications less than 2 cubic centimeters in extent) —– coarse needle aspiration or local excisional biopsy. For mammograms with distinctive features, especially for lesions with calcifications as the main manifestation without obvious masses or nodules, ultrasound can be used in combination with mammograms to find nodules or lesions of invasive breast cancer and intraductal carcinoma using “second-eye ultrasound”. If calcifications are found in the breast, there is no need to panic and be confused. You only need to follow the guidance of your breast specialist and combine it with other imaging tests for further clarification, surgical excision or follow-up examination if necessary.