Separate typically benign calcifications from suspicious ones by morphology (amorphous, coarse heterogeneous, fine pleomorphic, fine linear branching) and distribution (grouped, linear, segmental) — the combination sets the BI-RADS category and the biopsy.
Orient first
- Typically benign: skin, vascular, coarse popcorn, large rod-like, round, rim, dystrophic, milk of calcium, suture.
- Suspicious morphology in increasing order: amorphous, coarse heterogeneous, fine pleomorphic, fine linear or fine-linear branching (verify the current BI-RADS atlas).
- Linear and segmental distributions suggest ductal involvement (DCIS).
Acquire the study
- Standard CC and MLO views; magnification views (true lateral and CC) of the calcifications; specimen radiograph after biopsy.
The manoeuvre
- Magnification views: individual particle shape and size in mm.
- Milk of calcium: teacup shape on the true lateral, smudgy on CC — benign.
- Distribution: diffuse, regional, grouped (≤ 2 cm), linear, segmental; extent in mm.
- Compare with prior mammograms: new or increasing.
- Assign BI-RADS and recommend stereotactic or tomosynthesis-guided biopsy for category 4–5.
What confirms it
- Suspicious morphology or distribution on magnification views — histology after vacuum-assisted biopsy.
What licenses you to exclude it
- Typically benign calcifications need no further work-up (BI-RADS 2).
The classic misread
- Skipping magnification views and calling amorphous calcifications benign.