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Case number:	168
Age:	65
Clinical presentation:	Postmenopausal woman with average risk of developing breast carcinoma presented for screening. CBE revealed a small nodule palpable in the lower quadrant of the left breast.

Mammography:

Breast composition:	ACR category a (the breasts are almost entirely fatty)
Mammography features:
‣ Location of the lesion:	2017: Right breast, vascular calcification
‣ Mass:
• Number:	0
• Size:
• Shape:	None
• Margins:	None
• Density:	None
‣ Calcifications:
• Typically benign:	Vascular calcification
• Suspicious:	None
• Distribution:	None
‣ Architectural distortion:	None
‣ Asymmetry:	None
‣ Intramammary node:	None
‣ Skin lesion:	None
‣ Solitary dilated duct:	None
‣ Associated features:	None

Breast composition:	ACR category a (the breasts are almost entirely fatty)
Mammography features:
‣ Location of the lesion:	2017: Left breast, lower inner quadrant at 7 o’clock, middle third
‣ Mass:
• Number:	1
• Size:	1.6 × 1.2 cm
• Shape:	Oval
• Margins:	Circumscribed with perilesional halo
• Density:	Equal
‣ Calcifications:
• Typically benign:	Coarse
• Suspicious:	None
• Distribution:	Macrocalcifications within the mass
‣ Architectural distortion:	None
‣ Asymmetry:	None
‣ Intramammary node:	None
‣ Skin lesion:	None
‣ Solitary dilated duct:	None
‣ Associated features:	Calcifications

Breast composition:	ACR category a (the breasts are almost entirely fatty)
Mammography features:
‣ Location of the lesion:	2017: Left breast, upper outer quadrant at 1–2 o’clock, middle third
‣ Mass:
• Number:	0
• Size:
• Shape:	None
• Margins:	None
• Density:	None
‣ Calcifications:
• Typically benign:	None
• Suspicious:	Suspicious calcifications
• Distribution:	Numerous calcifications, > 5 in number, seen grouped together, in less than 2 cm of breast tissue, regional distribution
‣ Architectural distortion:	None
‣ Asymmetry:	None
‣ Intramammary node:	None
‣ Skin lesion:	None
‣ Solitary dilated duct:	None
‣ Associated features:	None

Breast composition:	ACR category a (the breasts are almost entirely fatty)
Mammography features:
‣ Location of the lesion:	2018: Follow-up mammogram shows stable calcifications in the upper outer quadrant of the left breast, Middle third, BI-RADS 2 (benign)
‣ Mass:
• Number:	0
• Size:
• Shape:	None
• Margins:
• Density:
‣ Calcifications:
• Typically benign:	None
• Suspicious:	None
• Distribution:
‣ Architectural distortion:
‣ Asymmetry:
‣ Intramammary node:
‣ Skin lesion:
‣ Solitary dilated duct:
‣ Associated features:	None

BI-RADS:

BI-RADS Category (2017): 3 (probably benign)
BI-RADS Category (at follow-up (2018)): 2 (benign)

Case summary:

Postmenopausal woman presented with left breast nodule. Diagnosed as involuting (partially calcified) fibroadenoma in the left breast, BI-RADS 2 on Imaging. Survey of bilateral breast mammogram reveals grouped calcifications of suspicious morphology in the left breast on initial assessment, BI-RADS 3. Regular annual follow-up reveals stable unchanged calcifications in the left breast, diagnosed as BI-RADS 2 on imaging.

Learning points:

Solitary group of round or punctate calcifications are BI-RADS 3 (probably benign). Stability on follow-up confirms the benign nature of calcifications, which can be categorized as BI-RADS 2 (benign finding).