A 45-year-old woman's mammogram shows grouped fine linear branching microcalcifications in a segmental distribution. Which BI-RADS descriptor best characterizes these calcifications, and what is the clinical implication?
- A Suspicious (fine linear branching in segmental distribution); biopsy required — associated with ductal carcinoma in situ (DCIS) ✓
- B Typically benign (coarse heterogeneous); routine recall
- C Probably benign; 6-month follow-up mammogram
- D High probability benign (round/punctate); annual screening
Correct answer: A. Suspicious (fine linear branching in segmental distribution); biopsy required — associated with ductal carcinoma in situ (DCIS)
Explanation
Fine linear and fine linear branching (casting) microcalcifications distributed in a segmental or linear pattern are the most suspicious descriptors in BI-RADS, with the highest PPV for ductal carcinoma in situ (DCIS), particularly high-grade comedo DCIS. They reflect calcium depositing within neoplastic cells filling ducts. Segmental distribution implies involvement along a ductal segment toward the nipple. These require stereotactic core biopsy. Coarse heterogeneous calcifications are intermediate; round/punctate are typically benign.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.