Mammographic Vascular Microcalcifications as a Surrogate Parameter for Coronary Heart Disease: Correlation to Cardiac Computer Tomography and Proposal of a Classification Score
Objective: This study develops a BI-RADS-like scoring system for vascular microcalcifications in mammographies, correlating breast arterial calcification (BAC) in a mammography with coronary artery calcification (CAC), and specifying differences between microcalcifications caused by BAC and microcal...
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MDPI AG
2024-12-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/14/24/2803 |
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| author | Jonathan Andreas Saenger Ela Uenal Eugen Mann Stephan Winnik Urs Eriksson Andreas Boss |
| author_facet | Jonathan Andreas Saenger Ela Uenal Eugen Mann Stephan Winnik Urs Eriksson Andreas Boss |
| author_sort | Jonathan Andreas Saenger |
| collection | DOAJ |
| description | Objective: This study develops a BI-RADS-like scoring system for vascular microcalcifications in mammographies, correlating breast arterial calcification (BAC) in a mammography with coronary artery calcification (CAC), and specifying differences between microcalcifications caused by BAC and microcalcifications potentially associated with malignant disease. Materials and Methods: This retrospective single-center cohort study evaluated 124 consecutive female patients (with a median age of 57 years). The presence of CAC was evaluated based on the Agatston score obtained from non-enhanced coronary computed tomography, and the calcifications detected in the mammography were graded on a four-point Likert scale, with the following criteria: (1) no visible or sporadically scattered microcalcifications, (2) suspicious microcalcification not distinguishable from breast arterial calcification, (3) minor breast artery calcifications, and (4) major breast artery calcifications. Inter-rater agreement was assessed in three readers using the Fleiss’ kappa, and the correlation between CAC and BAC was evaluated using the Spearman’s rank-order and by the calculation of sensitivity/specificity. Results: The reliability of the visual classification of BAC was high, with an overall Fleiss’ kappa for inter-rater agreement of 0.76 (ranging between 0.62 and 0.89 depending on the score). In 15.1% of patients, a BAC score of two was assigned indicating calcifications indistinguishable regarding vascular or malignant origin. In 17.7% of patients, minor or major breast artery calcifications were found (BAC 3–4). BAC was more prevalent among the patients with CAC (<i>p</i> < 0.001), and the severity of CAC increased with the BAC score; in the group with a BAC score of one, 15% of patients exhibited mild and severe CAC, in those with a BAC of two, this was 31%, in those with BAC of three, this was 38%, and in those with a BAC of four, this was 44%. The sensitivity for detecting CAC, based on the mammographic BAC score, was 30.3% at a specificity of 96.7%. Conclusions: The standardized visual grading of BAC in mammographies on a four-point scale is feasible with substantial interobserver agreement, potentially improving the treatment of patients with suspicious microcalcifications and CAC. |
| format | Article |
| id | doaj-art-9ab82c084d9344a982fd11d520488a79 |
| institution | OA Journals |
| issn | 2075-4418 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
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| series | Diagnostics |
| spelling | doaj-art-9ab82c084d9344a982fd11d520488a792025-08-20T02:00:37ZengMDPI AGDiagnostics2075-44182024-12-011424280310.3390/diagnostics14242803Mammographic Vascular Microcalcifications as a Surrogate Parameter for Coronary Heart Disease: Correlation to Cardiac Computer Tomography and Proposal of a Classification ScoreJonathan Andreas Saenger0Ela Uenal1Eugen Mann2Stephan Winnik3Urs Eriksson4Andreas Boss5Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, 8091 Zurich, SwitzerlandDiagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, 8091 Zurich, SwitzerlandInstitute of Diagnostic and Interventional Radiology, GZO Regional Health Center, 8620 Wetzikon, SwitzerlandDivision of Cardiology, Department of Medicine, GZO Regional Health Center, 8620 Wetzikon, SwitzerlandDivision of Cardiology, Department of Medicine, GZO Regional Health Center, 8620 Wetzikon, SwitzerlandInstitute of Diagnostic and Interventional Radiology, GZO Regional Health Center, 8620 Wetzikon, SwitzerlandObjective: This study develops a BI-RADS-like scoring system for vascular microcalcifications in mammographies, correlating breast arterial calcification (BAC) in a mammography with coronary artery calcification (CAC), and specifying differences between microcalcifications caused by BAC and microcalcifications potentially associated with malignant disease. Materials and Methods: This retrospective single-center cohort study evaluated 124 consecutive female patients (with a median age of 57 years). The presence of CAC was evaluated based on the Agatston score obtained from non-enhanced coronary computed tomography, and the calcifications detected in the mammography were graded on a four-point Likert scale, with the following criteria: (1) no visible or sporadically scattered microcalcifications, (2) suspicious microcalcification not distinguishable from breast arterial calcification, (3) minor breast artery calcifications, and (4) major breast artery calcifications. Inter-rater agreement was assessed in three readers using the Fleiss’ kappa, and the correlation between CAC and BAC was evaluated using the Spearman’s rank-order and by the calculation of sensitivity/specificity. Results: The reliability of the visual classification of BAC was high, with an overall Fleiss’ kappa for inter-rater agreement of 0.76 (ranging between 0.62 and 0.89 depending on the score). In 15.1% of patients, a BAC score of two was assigned indicating calcifications indistinguishable regarding vascular or malignant origin. In 17.7% of patients, minor or major breast artery calcifications were found (BAC 3–4). BAC was more prevalent among the patients with CAC (<i>p</i> < 0.001), and the severity of CAC increased with the BAC score; in the group with a BAC score of one, 15% of patients exhibited mild and severe CAC, in those with a BAC of two, this was 31%, in those with BAC of three, this was 38%, and in those with a BAC of four, this was 44%. The sensitivity for detecting CAC, based on the mammographic BAC score, was 30.3% at a specificity of 96.7%. Conclusions: The standardized visual grading of BAC in mammographies on a four-point scale is feasible with substantial interobserver agreement, potentially improving the treatment of patients with suspicious microcalcifications and CAC.https://www.mdpi.com/2075-4418/14/24/2803breast cancerscreeningmammographycoronary heart disease |
| spellingShingle | Jonathan Andreas Saenger Ela Uenal Eugen Mann Stephan Winnik Urs Eriksson Andreas Boss Mammographic Vascular Microcalcifications as a Surrogate Parameter for Coronary Heart Disease: Correlation to Cardiac Computer Tomography and Proposal of a Classification Score Diagnostics breast cancer screening mammography coronary heart disease |
| title | Mammographic Vascular Microcalcifications as a Surrogate Parameter for Coronary Heart Disease: Correlation to Cardiac Computer Tomography and Proposal of a Classification Score |
| title_full | Mammographic Vascular Microcalcifications as a Surrogate Parameter for Coronary Heart Disease: Correlation to Cardiac Computer Tomography and Proposal of a Classification Score |
| title_fullStr | Mammographic Vascular Microcalcifications as a Surrogate Parameter for Coronary Heart Disease: Correlation to Cardiac Computer Tomography and Proposal of a Classification Score |
| title_full_unstemmed | Mammographic Vascular Microcalcifications as a Surrogate Parameter for Coronary Heart Disease: Correlation to Cardiac Computer Tomography and Proposal of a Classification Score |
| title_short | Mammographic Vascular Microcalcifications as a Surrogate Parameter for Coronary Heart Disease: Correlation to Cardiac Computer Tomography and Proposal of a Classification Score |
| title_sort | mammographic vascular microcalcifications as a surrogate parameter for coronary heart disease correlation to cardiac computer tomography and proposal of a classification score |
| topic | breast cancer screening mammography coronary heart disease |
| url | https://www.mdpi.com/2075-4418/14/24/2803 |
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