38 - Advanced calcification analysis - 4A&B

Advanced calcification analysis lectures

Perception and management of cases with powdery, dust-like, cotton-ball-like calcifications is full of difficulties. The underlying histopathologic diagnosis in cases with powdery/cotton ball-like microcalcifications on the mammogram is Grade 1 CIS within the TDLUs in half of the cases and sclerosing adenosis in the remaining half. Further problems arise when these calcification are caused by benign sclerosing adenosis, but noncalcified and mammographically occult Grade 1 CIS may also be found close to the calcifications. There are additional cases showing rare presentations of cancers originating in the major lactiferous ducts where the newly formed duct-like structures form a spherical conglomerate, with a real surprise in one case when the cancer spreads through a vein! The lecture concludes with many clinical, imaging and histopathologic aspects of Paget’s disease.

These carefully chosen, fully worked-up cases cover the full spectrum of malignant-type calcifications seen at mammography. You will learn how to find faint and subtle calcifications and recognize malignancy by the distribution of the calcifications, even when the individual calcifications appear benign. Our multimodality diagnostic approach benefits from the strengths of magnification mammography, ultrasound and MRI. The imaging findings are correlated in every case with large format thin section (and often thick section) histopathology images to show the underlying structure of the malignancies we see at imaging. Every case has illustrated teaching points reviewing the major findings and commenting on the appropriateness of the management. These lectures improve your skills in perception and diagnosis and give you greater confidence when communicating your findings to your pathologists and surgeons.