Winston J S, Yeh I T, Evers K, Friedman A K
Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia.
Am J Clin Pathol. 1993 Nov;100(5):488-92. doi: 10.1093/ajcp/100.5.488.
Breast biopsies are commonly performed for abnormal, usually clustered, calcifications detected by mammography. Calcium phosphate is the predominant form of calcium seen in breast tissue and is frequently associated with malignancy. Calcium oxalate, which can also be present in breast tissue, has been exclusively associated with benign lesions. Thus, if mammography could distinguish calcium phosphate from calcium oxalate, biopsy could be avoided in some patients. Pathologic findings and corresponding mammograms of 55 patients who underwent biopsy for abnormal calcifications were reviewed. The authors evaluated such pathologic features as type of calcification, anatomic location, and association with fibrocystic changes or carcinoma. Mammographically, calcifications were categorized by size, distribution, and morphology, and each was assigned a density rating of low, medium, or high. Of the 55 cases, 41 contained calcium phosphate only, 8 contained calcium oxalate only, and 6 contained both. If only calcium oxalate was present, the calcium was always associated with benign epithelium. Of 47 cases, calcium phosphate was associated with benign breast disease in 28 and with carcinoma in 19. Five of six cases with both calcium phosphate and calcium oxalate contained carcinoma; calcium phosphate was seen in the carcinoma area in all five. Radiologically, calcium phosphate was typically medium to high density, whereas calcium oxalate was characterized as amorphous, low to medium density. Other low-density calcifications were almost always benign, unless pleomorphic in shape. Although further work is necessary to confirm these findings, it appears that, radiologically, low-density, amorphous, calcifications, even if clustered, are associated with benign breast disease, and may represent calcium oxalate. Patients with such calcifications may be managed conservatively.
乳腺活检通常用于对乳腺钼靶检查发现的异常（通常为簇状）钙化灶进行诊断。磷酸钙是乳腺组织中钙的主要存在形式，常与恶性肿瘤相关。乳腺组织中也可能存在的草酸钙则仅与良性病变相关。因此，如果乳腺钼靶检查能够区分磷酸钙和草酸钙，部分患者或许可以避免活检。回顾了55例因异常钙化灶接受活检患者的病理结果及相应的乳腺钼靶图像。作者评估了钙化类型、解剖位置以及与纤维囊性变或癌的关联等病理特征。在乳腺钼靶图像上，钙化灶根据大小、分布和形态进行分类，并分别赋予低、中、高的密度评级。55例病例中，41例仅含磷酸钙，8例仅含草酸钙，6例两者皆有。若仅存在草酸钙，其总是与良性上皮相关。在47例含磷酸钙的病例中，28例与良性乳腺疾病相关，19例与癌相关。6例同时含有磷酸钙和草酸钙的病例中有5例含有癌；所有5例癌灶区域均可见磷酸钙。在影像学上，磷酸钙通常为中到高密度，而草酸钙表现为无定形、低到中等密度。其他低密度钙化灶几乎总是良性的，除非形态呈多形性。尽管需要进一步研究来证实这些发现，但从影像学角度看，低密度、无定形的钙化灶，即使呈簇状，似乎也与良性乳腺疾病相关，可能代表草酸钙。有此类钙化灶的患者或许可采取保守治疗。
