With the increasing maturity of high-definition mammography and high-frequency ultrasound technology, for more and more women who have not touched the lump clinically, in the process of examination, in addition to discovering various manifestations of breast diseases, about 2/3 of them can have calcification shadow in the breast. Calcification often occurs in the area of degeneration and necrosis of cancer cells, which is manifested as heaps of sand-like calcification, and sand-like calcification can be seen at the edge of the lump. This is because calcification after necrosis of tumor cells occurs in the necrotic debris at the margin of an infiltrating mass. Therefore, calcifications around the lesion have the same clinical significance. The presence of clusters of fine particulate calcifications with irregular calcifications in the clusters of calcifications without a shadow of the mass may be considered diagnostic of malignancy. In conjunction with the clinic, the display of tiny calcified foci, if added to the breast, is significant for early detection of breast cancer. Characteristics of breast cancer calcification in high-frequency ultrasound and X-ray radiography Calcified particles are small, with a diameter of 10-500 μm, usually not more than 1000 μm. on X-ray radiographs, the visibility of the naked eye is about 150 μm. for dense breasts or mammograms with poor backgrounds, it is often necessary to use magnifying glasses to identify calcified foci. Improvements in ultrasound performance and the use of high-frequency probes have made it possible to visualize microcalcifications with ultrasound. Ultrasound can detect small beads of 110 μm in a hypoechoic background simulating breast cancer, whereas the smallest bead detected by radiography is 200 μm. The detection rates of microcalcifications in breast cancer by high-frequency ultrasound and radiography are 56% and 35%, respectively. However, it has been reported that ultrasound and MRI cannot easily detect microcalcifications due to their limitations. Different types and significance of calcification I. Typical benign calcification 1. Skin calcification: the center is translucent in typical cases, and atypical cases can be identified with the help of tangential projection. Vascular calcification: tubular or orbital. 3, Rough or bract-shaped calcification: characteristic manifestation of fibroadenoma calcification. 4, Rough rod-like calcification: continuous rod-like, occasionally branching, usually larger than 1 mm in diameter, may show central translucent changes. These calcifications are common in secretory lesions, such as plasma cell mastitis and ductal dilatation. Rounded calcifications: If multiple, they may be of different sizes. For those smaller than 1mm, they are often located in the lobular follicles. For those less than 0.5mm, they can be called punctate calcifications. 6, ring or eggshell-like calcification: ring wall is very thin, often less than 1mm, for the spherical object surface deposition of calcification. It is seen in fat necrosis or cyst. 7, hollow calcification: the size can be from 1mm to 25px, or even larger, with smooth edges, round or oval shape, and low density in the center. The thickness of the wall is greater than that of annular or eggshell-like calcification. Commonly seen in fat necrosis, the remains of calcification in the duct, occasionally seen in fibroadenoma. 8, milk-like calcification: calcification within the cyst. In the axial position, it is not obvious, and it is fluffy or indeterminate in shape. In the lateral position, the boundary is clear, and according to the different morphology of the cyst, it is manifested as semilunar, crescentic, curvilinear or linear. Suture calcification: calcium deposits on the suture material, especially common after radiotherapy. Typically linear or tubular, knot-like changes can often be seen. 10.Dystrophic calcification: often seen in the breast after radiotherapy or trauma, the calcification pattern is irregular, mostly larger than 0.5mm, showing hollow tubular changes. Dotted calcification: round or ovoid calcification with diameter less than 0.5mm and clear margin. Calcifications that cannot be characterized Indeterminate or fuzzy calcifications, often round or lamellar, very small and fuzzy, the nature of which cannot be determined morphologically. Calcifications with high malignant potential 1, polymorphic and heterogeneous calcification (granular punctate calcification): more suspicious than indeterminate calcification, its size and shape are different, and its diameter is often less than 0.5mm. 2, linear or linear branching calcification (cast calcification): fine and irregular linear calcification, often discontinuous, and its diameter is less than 0.5mm, these signs suggest that the calcification is formed from the lumen of ducts that are invaded by breast cancer. These signs suggest that the calcification is formed from the lumen of the duct invaded by breast cancer. Distribution mode 1.Cluster: It was previously considered as a malignant distribution pattern, but now it is considered as a neutral distribution pattern, both benign and malignant. It refers to clustered calcification less than 50px cubic range. 2.Linear: arranged in a linear shape, with branching points visible. 3.Segmental: it often suggests that the lesion originates from a duct and its branches, or it may be a multifocal carcinoma occurring in a lobe or a segmental lobe. Although benign secretory lesions may also have segmental calcification, if the morphology of calcification is not characteristically benign, malignant calcification should be considered as the first step, and most of the calcifications are carcinoma in situ of the ducts if they are not accompanied by a mass. 4.Regional: Calcifications in a larger area can not be described by segmental or cluster. 5. Diffuse or scattered: randomly distributed throughout the breast. V. Note 1: When encountering a relatively large number of calcifications, what is important is not the number of calcifications, but the morphology of each calcification. If each calcification is small but rounded or well demarcated from the others, it is usually benign, regardless of the number, even if there are several within a 50-px area, such as the “randomly distributed throughout the breast” type. Except for plasma cell mastitis which can be easily misdiagnosed as cancer, the manifestation of traumatic fat necrosis is more similar to breast cancer, in which localized fat necrosis forms lumps with burrs and calcification. However, this kind of calcification is less likely to occur, and will be confined to the localized lesion, not widely extended. The value of breast calcification in the diagnosis of breast cancer I. Incidence of calcification in breast cancer Calcification is one of the common imaging manifestations of breast cancer. Certain specific forms of calcification are risk factors for breast cancer. Statistics show that 65% of breast cancers have calcification, of which 70% are malignant calcification. Clusters of tiny calcifications are often the only X-ray sign of early breast cancer. According to the morphology, size, number and density of microcalcifications, the nature and scope of the lesion can be reflected. Microcalcifications can be located in or around the mass, with a total number of 6-15, uneven density and different sizes. Mammography can improve the diagnostic rate of occult cancer, microcarcinoma (less than 10mm in diameter) and early cancer. It is difficult to characterize the lumps with diameter less than 10mm, but sandy calcification is often an alarm of malignant lesions; if there are signs of peripheral structural disorders, bilateral asymmetry and coarsening of vascular shadow at the same time, then malignant lesions are more likely to occur. Formation of microcalcifications in malignant breast lesions The number of microcalcifications per unit area of malignant breast lesions is high, which may be caused by the necrosis of cancerous tissues and secretion of cancerous cells and other reasons. Different densities and sizes of calcification points may be due to the difference in the time of calcium salt deposition, and the first calcification formed with the prolongation of time is relatively higher in density and larger in size. The difference between benign and malignant calcification Compared with benign calcification, the average density of malignant calcification group is lower, and the density and size have greater value in identifying benign and malignant breast diseases. The distribution of microcalcifications in mammograms seems to be irregular, but when the cancer is found to occur in the terminal ducts, the calcifications may be located in the large necrotic tissues or among the cancer cells, and may also exist in the superior ducts or at the bifurcation of the ducts or in the adjacent follicular lumen. Regional calcification of cancer foci may be of fine sand or mixed type, and intraductal calcification may be of worm type, which may be related to the abnormal secretion of the tumor along the ductal drainage. When the cancer is located in larger ducts, the calcification away from the lesion is often located in the peripheral lower level ducts, and is mainly of fine sand type, which may be produced by the abnormal metabolites of the cancer cells or the reflux of the cancer cells to stimulate the peripheral ducts and glandular follicles. The large number, fine granularity and rough edges, which can be located inside or outside the block shadow, suggest malignancy. Principles of morphologic analysis of calcification in mammograms I. In conventional mammography, due to the overly dense breast gland, overlapping tissues and inherent resolution limitations of the equipment, smaller calcifications may be missed or difficult to determine. Frequently encountered cases are: ① confirmed; ② unclear benign or malignant; ③ missed or misdiagnosed. The size, shape, density, number and distribution of calcifications may have some correlation with their benign or malignant nature, which can be used as reference factors for differential diagnosis of benign and malignant calcifications. The more the number of calcifications in a certain volume range, the more the number of microcalcifications, ≥5 microcalcifications clustered in 25px2 range, the possibility of breast cancer is very high; <5, benign lesions; but the diameter of calcification particles <0.5mm, the density of varying depths, pitting, branch-like or mud-like calcification, with microcalcifications in or around the mass, for breast cancer. The morphology is: granular fine, mud-like, fine line, branched, etc., and a larger number of specific calcifications help in the diagnosis of breast cancer. Differential diagnosis of benign and malignant breast microcalcifications is very difficult problem. Microcalcifications are not specific signs of breast cancer, but have important significance in the differential diagnosis of benign and malignant. Third, the molybdenum target film fails to show the mass shadow (mostly dense gland) and only shows calcification, which has a great overlap in both benign and malignant lesions; breast cancer calcification is mostly located in the necrotic area of the tumor, which can also be located in the connective tissue around the tumor, and there is also calcification not accompanied by a mass. The rate of malignancy is significantly higher in the case of single-form microcalcifications not associated with a mass, when such calcifications are present in or around the mass. If in clusters of tiny calcifications, the size of calcification particles in the range of 0.01 ~ 0.5mm diameter, the density of varying shades, a variety of morphology, point-like, branch-like or both of the sediment-like calcification, regardless of the presence of mass in the group of calcifications, there is a diagnostic value of malignancy. Application of molybdenum target photography for localization and puncture of hidden lesions will significantly improve the detection of breast cancer. V. Diseases that often have calcification in the pathological examination results of clinical breast cases: breast cancer: intraductal carcinoma, lobular carcinoma in situ, limited infiltration of intraductal carcinoma, limited carcinoma of intraductal papilloma, carcinoma in the ductal epithelial atypical hyperplasia cell, invasive ductal carcinoma, invasive lobular carcinoma. Benign breast lesions: among others, mastopathy, fibroadenoma, intraductal papilloma, ductal dilatation and cysts, lobular hyperplasia of the breast, lobular hyperplasia of the breast with atypical hyperplasia. Intraductal carcinoma of the breast is predominantly characterized by ductal calcifications or calcifications along the ductal course in radiographs, simple carcinoma and invasive ductal carcinoma are predominantly characterized by granular or acinar calcifications in radiographs, but gross calcifications are also seen in radiographs of breast carcinoma. For further diagnosis of patients with clustered calcification I. Diagnostic methods of breast calcification X-ray-guided coarse needle aspiration biopsy, ultrasound-guided coarse needle aspiration biopsy and X-ray-guided metal wire localization excisional biopsy have been carried out at home and abroad for occult lesions. In comparison, ultrasound was inferior to X-ray in showing microcalcifications in the breast, and X-ray coarser needle aspiration biopsy was superior to X-ray coarser needle aspiration biopsy in terms of the completeness of the dissection of breast calcification points. Preoperative localization of the calcified point in the breast with molybdenum target mammography The patient takes the standing or sitting position, and the breast is fixed on the pallet of the mammography machine so that it is in the state of compression. The location of the point of calcification in the breast is positioned in the coordinate hole, and a puncture needle with a metal localization wire is inserted through the skin. When the tip of the needle reaches and slightly exceeds the point of calcification, the needle is withdrawn, and the metal localization wire with a "barbed hook" is left in the breast. One or two positioning wires are placed in each case, and lateral and axial films are taken for reference during surgery. The patient takes the supine position or lateral position, when designing the incision position, it is not only conducive to the removal of all the calcified points, but also consider the effect of breast shape, routine disinfection, local anesthesia or local anesthesia intensification, and the surgical process is always carried out under the guidance of the metal positioning line. Strive to clinically negative palpation in the breast of the tiny calcification points are all once all excision. After the mass is cut off, it is first sent to the diagnostic department to take a photo to make sure that all the calcified points are included in the specimen before it is sent to the pathology department for diagnosis, and if it is found that there is a calcified point that has not been excised, it should also be cut. During the operation, all the metal localization wires were taken out, and there was no broken or leftover phenomenon.