{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T11:08:45Z","timestamp":1779880125127,"version":"3.53.1"},"reference-count":38,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T00:00:00Z","timestamp":1679443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deutsche Forschungsgemeinschaft"},{"name":"Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: In the German Mammography Screening Program, 62% of ductal carcinoma in situ (DCIS) and 38% of invasive breast cancers are associated with microcalcifications (MCs). Vacuum-assisted stereotactic breast biopsies are necessary to distinguish precancerous lesions from benign calcifications because mammographic discrimination is not possible. The aim of this study was to investigate if breast magnetic resonance imaging (MRM) could assist the evaluation of MCs and thus help reduce biopsy rates. Methods: In this IRB-approved study, 58 women (mean age 58 +\/\u2212 24 years) with 59 suspicious MC clusters in the MG were eligible for this prospective single-center trial. Additional breast magnetic resonance imaging (MRI) was conducted before biopsy. Results: The breast MRI showed a sensitivity of 86%, a specificity of 84%, a positive predictive value (PPV) of 75% and a negative predictive value (NPV) of 91% for the differentiation between benign and malignant in these 59 MCs found with MG. Breast MRI in addition to MG could increase the PPV from 36% to 75% compared to MG alone. The MRI examination led to nine additional suspicious classified lesions in the study cohort. A total of 55% (5\/9) of them turned out to be malignant. A total of 32 of 59 (54 %) women with suspicious MCs and benign histology were classified as non-suspicious by MRI. Conclusion: An additionally performed breast MRI could have increased the diagnostic reliability in the assessment of MCs. Further, in our small cohort, a considerable number of malignant lesions without mammographically visible MCs were revealed.<\/jats:p>","DOI":"10.3390\/diagnostics13061197","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T06:00:01Z","timestamp":1679464801000},"page":"1197","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Low-Risk Women with Suspicious Microcalcifications in Mammography\u2014Can an Additional Breast MRI Reduce the Biopsy Rate?"],"prefix":"10.3390","volume":"13","author":[{"given":"Patrik","family":"P\u00f6schke","sequence":"first","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital Erlangen, Universit\u00e4tsstra\u00dfe 21-23, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn","family":"Wenkel","sequence":"additional","affiliation":[{"name":"Radiologie M\u00fcnchen, Burgstra\u00dfe 7, 80331 M\u00fcnchen, Germany"},{"name":"Medizinische Fakult\u00e4t, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin C.","family":"Hack","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital Erlangen, Universit\u00e4tsstra\u00dfe 21-23, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias W.","family":"Beckmann","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital Erlangen, Universit\u00e4tsstra\u00dfe 21-23, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Uder","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9163-8840","authenticated-orcid":false,"given":"Sabine","family":"Ohlmeyer","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,22]]},"reference":[{"key":"ref_1","unstructured":"(2023, February 20). Krebs in Deutschland 2017\/2018. Robert Koch Institut\u2014Zentrum f\u00fcr Krebsregisterdaten. Available online: https:\/\/www.krebsdaten.de\/Krebs\/DE\/Content\/Publikationen\/Krebs_in_Deutschland\/kid_2021\/kid_2021_c50_brust.pdf?__blob=publicationFile."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"279","DOI":"10.7326\/M15-2886","article-title":"Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement","volume":"164","author":"Siu","year":"2016","journal-title":"Ann. Intern. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1148\/radiol.2016161106","article-title":"MR Imaging for Diagnosis of Malignancy in Mammographic Microcalcifications: A Systematic Review and Meta-Analysis","volume":"283","author":"Baltzer","year":"2017","journal-title":"Radiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1055\/s-0032-1313102","article-title":"Breast microcalcifications as type descriptors to stratify risk of malignancy: A systematic review and meta-analysis of 10665 cases with special focus on round\/punctate microcalcifications","volume":"184","author":"Rominger","year":"2012","journal-title":"Rofo"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1148\/radiol.12111461","article-title":"Comparison of digital screening mammography and screen-film mammography in the early detection of clinically relevant cancers: A multicenter study","volume":"265","author":"Bluekens","year":"2012","journal-title":"Radiology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1007\/s11547-007-0141-9","article-title":"Contrast-enhanced MR imaging in patients with BI-RADS 3-5 microcalcifications","volume":"112","author":"Cilotti","year":"2007","journal-title":"Radiol. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1148\/radiology.172.1.2544922","article-title":"Clinically occult ductal carcinoma in situ detected with mammography: Analysis of 100 cases with radiologic-pathologic correlation","volume":"172","author":"Stomper","year":"1989","journal-title":"Radiology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1038\/modpathol.2011.81","article-title":"Digital mammography: More microcalcifications, more columnar cell lesions without atypia","volume":"24","year":"2011","journal-title":"Mod. Pathol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1136\/jcp.2010.085860","article-title":"Digital mammography in a screening programme and its implications for pathology: A comparative study","volume":"64","author":"Feeley","year":"2011","journal-title":"J. Clin. Pathol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.breast.2018.07.007","article-title":"Breast-conserving therapy for primary Ductal Carcinoma in Situ in The Netherlands: A multi-center study and population-based analysis","volume":"42","author":"Jobsen","year":"2018","journal-title":"Breast"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1148\/radiol.2016161444","article-title":"Supplemental Breast MR Imaging Screening of Women with Average Risk of Breast Cancer","volume":"283","author":"Kuhl","year":"2017","journal-title":"Radiology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s00330-013-3029-1","article-title":"3-T breast magnetic resonance imaging in patients with suspicious microcalcifications on mammography","volume":"24","author":"Stehouwer","year":"2014","journal-title":"Eur. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1148\/rg.336125055","article-title":"Ductal carcinoma in situ of the breasts: Review of MR imaging features","volume":"33","author":"Greenwood","year":"2013","journal-title":"Radiographics"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1148\/radiol.2461061298","article-title":"Meta-analysis of MR imaging in the diagnosis of breast lesions","volume":"246","author":"Peters","year":"2008","journal-title":"Radiology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1056\/NEJMoa065447","article-title":"MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer","volume":"356","author":"Lehman","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/S0140-6736(07)61232-X","article-title":"MRI for diagnosis of pure ductal carcinoma in situ: A prospective observational study","volume":"370","author":"Kuhl","year":"2007","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1002\/ijc.29534","article-title":"Survival benefit in women with BRCA1 mutation or familial risk in the MRI screening study (MRISC)","volume":"137","author":"Saadatmand","year":"2015","journal-title":"Int. J. Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1007\/s10549-014-2931-9","article-title":"MRI breast screening in high-risk women: Cancer detection and survival analysis","volume":"145","author":"Evans","year":"2014","journal-title":"Breast Cancer Res. Treat"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1038\/bjc.2012.204","article-title":"Long-term results of screening with magnetic resonance imaging in women with BRCA mutations","volume":"107","author":"Passaperuma","year":"2012","journal-title":"Br. J. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4036","DOI":"10.1007\/s00330-022-08617-6","article-title":"Breast Cancer Screening in Women with Extremely Dense Breasts Recommendations of the European Society of Breast Imaging (EUSOBI)","volume":"32","author":"Mann","year":"2022","journal-title":"Eur. Radiol."},{"key":"ref_21","unstructured":"Sickles, E., D\u2019Orsi, C.J., and Bassett, L.W. (2013). ACR BI-RADS\u00ae Atlas, Breast Imaging Reporting and Data System, American College of Radiology."},{"key":"ref_22","unstructured":"(2023, February 21). Vereinbarung von Qualit\u00e4tssicherungsma\u00dfnahmen nach \u00a7 135 Abs. 2 SGB V zur kurativen Mammographie (Mammographie-Vereinbarung). 2011: Deutsches \u00c4rzteblatt International Jg. 108 Heft 14. A-791\u2013A-796. Available online: https:\/\/www.referenzzentrum-ms.de\/site\/assets\/files\/2132\/kurative_mammographie_endversion.pdf."},{"key":"ref_23","unstructured":"Morris, E.A., and Lee, C.H. (2013). ACR BI-RADS\u00ae Atlas, Breast Imaging Reporting and Data System, American College of Radiology."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.2214\/AJR.09.3423","article-title":"The positive predictive value of BI-RADS microcalcification descriptors and final assessment categories","volume":"194","author":"Bent","year":"2010","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.ejrad.2015.09.020","article-title":"Differentiation of ductal carcinoma in-situ from benign micro-calcifications by dedicated breast computed tomography","volume":"85","author":"Abbey","year":"2016","journal-title":"Eur. J. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1148\/radiol.14140645","article-title":"Assessment of BI-RADS category 4 lesions detected with screening mammography and screening US: Utility of MR imaging","volume":"274","author":"Strobel","year":"2015","journal-title":"Radiology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2540","DOI":"10.1002\/cncr.28820","article-title":"Implementation of the National Breast and Cervical Cancer Early Detection Program: The beginning","volume":"120","author":"Lee","year":"2014","journal-title":"Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1007\/s00330-009-1396-4","article-title":"The clinical value of bilateral breast MR imaging: Is it worth performing on patients showing suspicious microcalcifications on mammography?","volume":"19","author":"Akita","year":"2009","journal-title":"Eur. Radiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1093\/jnci\/92.13.1081","article-title":"Breast Density as a Predictor of Mammographic Detection: Comparison of Interval- and Screen-Detected Cancers","volume":"92","author":"Mandelson","year":"2000","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1056\/NEJMoa062790","article-title":"Mammographic density and the risk and detection of breast cancer","volume":"356","author":"Boyd","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1055\/s-0043-102694","article-title":"Mammographic Density and Vitamin D Levels\u2014A Cross-sectional Study","volume":"77","author":"Straub","year":"2017","journal-title":"Geburtshilfe Frauenheilkd."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1056\/NEJMoa1903986","article-title":"Supplemental MRI Screening for Women with Extremely Dense Breast Tissue","volume":"381","author":"Bakker","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1007\/s10549-019-05198-9","article-title":"Prognostic effect of Ki-67 in common clinical subgroups of patients with HER2-negative, hormone receptor-positive early breast cancer","volume":"175","author":"Fasching","year":"2019","journal-title":"Breast Cancer Res. Treat"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1148\/radiol.212361","article-title":"Contralateral Breast Screening with Preoperative MRI: Long-Term Outcomes for Newly Diagnosed Breast Cancer","volume":"304","author":"Freitas","year":"2022","journal-title":"Radiology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.mri.2017.10.012","article-title":"Is breast MRI a helpful additional diagnostic test in suspicious mammographic microcalcifications?","volume":"46","author":"Baltzer","year":"2018","journal-title":"Magn. Reson. Imaging"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1001\/jamaoncol.2015.2510","article-title":"Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ","volume":"1","author":"Narod","year":"2015","journal-title":"JAMA Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/978-3-319-70197-4_5","article-title":"Is DCIS Overrated?","volume":"173","author":"Feinberg","year":"2018","journal-title":"Cancer Treat Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"192","DOI":"10.3389\/fonc.2017.00192","article-title":"Paradigm Shift toward Reducing Overtreatment of Ductal Carcinoma In Situ of Breast","volume":"7","author":"Sagara","year":"2017","journal-title":"Front. Oncol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/6\/1197\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:00:16Z","timestamp":1760122816000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/6\/1197"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,22]]},"references-count":38,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["diagnostics13061197"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13061197","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,22]]}}}