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Insights into Imaging
Published in: Insights into Imaging 1/2023

Open Access 01-12-2023 | Mammography | Critical Review

Clinicopathological and prognostic value of calcification morphology descriptors in ductal carcinoma in situ of the breast: a systematic review and meta-analysis

Authors: Merle M. van Leeuwen, Shannon Doyle, Alexandra W. van den Belt–Dusebout, Stevie van der Mierden, Claudette E. Loo, Ritse M. Mann, Jonas Teuwen, Jelle Wesseling

Published in: Insights into Imaging | Issue 1/2023

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Abstract

Background

Calcifications on mammography can be indicative of breast cancer, but the prognostic value of their appearance remains unclear. This systematic review and meta-analysis aimed to evaluate the association between mammographic calcification morphology descriptors (CMDs) and clinicopathological factors.

Methods

A comprehensive literature search in Medline via Ovid, Embase.com, and Web of Science was conducted for articles published between 2000 and January 2022 that assessed the relationship between CMDs and clinicopathological factors, excluding case reports and review articles. The risk of bias and overall quality of evidence were evaluated using the QUIPS tool and GRADE. A random-effects model was used to synthesize the extracted data. This systematic review is reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).

Results

Among the 4715 articles reviewed, 29 met the inclusion criteria, reporting on 17 different clinicopathological factors in relation to CMDs. Heterogeneity between studies was present and the overall risk of bias was high, primarily due to small, inadequately described study populations. Meta-analysis demonstrated significant associations between fine linear calcifications and high-grade DCIS [pooled odds ratio (pOR), 4.92; 95% confidence interval (CI), 2.64–9.17], (comedo)necrosis (pOR, 3.46; 95% CI, 1.29–9.30), (micro)invasion (pOR, 1.53; 95% CI, 1.03–2.27), and a negative association with estrogen receptor positivity (pOR, 0.33; 95% CI, 0.12–0.89).

Conclusions

CMDs detected on mammography have prognostic value, but there is a high level of bias and variability between current studies. In order for CMDs to achieve clinical utility, standardization in reporting of CMDs is necessary.

Critical relevance statement

Mammographic calcification morphology descriptors (CMDs) have prognostic value, but in order for CMDs to achieve clinical utility, standardization in reporting of CMDs is necessary.

Systematic review registration

CRD42022341599

Key points

• Mammographic calcifications can be indicative of breast cancer.
• The prognostic value of mammographic calcifications is still unclear.
• Specific mammographic calcification morphologies are related to lesion aggressiveness.
• Variability between studies necessitates standardization in calcification evaluation to achieve clinical utility.

Graphical Abstract

Appendix
Available only for authorised users
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Metadata
Title
Clinicopathological and prognostic value of calcification morphology descriptors in ductal carcinoma in situ of the breast: a systematic review and meta-analysis
Authors
Merle M. van Leeuwen
Shannon Doyle
Alexandra W. van den Belt–Dusebout
Stevie van der Mierden
Claudette E. Loo
Ritse M. Mann
Jonas Teuwen
Jelle Wesseling
Publication date
01-12-2023
Publisher
Springer Vienna
Published in
Insights into Imaging / Issue 1/2023
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1186/s13244-023-01529-z

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