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Atlas of breast cancer early detection

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Case number:151
Clinical presentation:Postmenopausal woman with increased risk of developing breast cancer presented for postoperative surveillance. She had undergone left breast-conserving surgery for invasive carcinoma and also has a family history of breast carcinoma.


Breast composition:ACR category a (the breasts are almost entirely fatty)
Mammography features:

 ‣ Location of the lesion:Left breast, upper outer quadrant at 2 o'clock, middle third and left axilla along surgical scar
 ‣ Mass:
   • Number:0
   • Size:None
   • Shape:None
   • Margins:None
   • Density:None
 ‣ Calcifications:
   • Typically benign:Eggshell, typically benign with lucent centres along surgical scar. Suture calcifications are also seen
   • Suspicious:None
   • Distribution:Dystrophic calcification and suture calcification seen at surgical scar in the left breast
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:None


BI-RADS Category: 2 (benign)

Case summary:

Postmenopausal woman who had undergone breast-conserving surgery for left breast carcinoma 8 years earlier presented for regular postoperative surveillance. Diagnosed as left breast surgical scar with dystrophic calcification and typically benign suture calcifications, BI-RADS 2 on imaging.

Learning points:

  • Eggshell calcifications with lucent centres are seen after surgery and radiotherapy because of fat necrosis changes. These are confidently labelled as typically benign-appearing calcifications. Close surveillance excludes malignant calcifications and the possibility of recurrent neoplasm.
  • After breast-conserving surgery, delayed resorption of the suture acts as a nidus for calcification. Suture calcification is seen as smooth linear or curvilinear calcifications or as calcified knots.

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