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Breast Arterial Calcifications in Mammography: Evaluating Diagnostic Accuracy, Reproducibility, and Clinical Feasibility of Visual Scoring Systems

Year: 2025

Type: article

Abstract: OBJECTIVE: This study evaluated (1) the reproducibility of 5 visual scoring systems for breast arterial calcifications (BACs) on mammography and their correlation with coronary artery calcifications (CACs), (2) their diagnostic accuracies, and (3) clinical applicability. METHODS: In this retrospective study, 90 women (median aged 57 years, interquartile range [IQR] 15) who underwent both mammography and cardiac CT were included. Breast arterial calcification was scored using 5 visual systems: (1) dichotomous (present/absent), (2) 4-level vessel count, (3) 4-level severity, (4) combined 4-level (severity + vessel count), and (5) an advanced 3-level scale (incorporating vessel count, length, and density). Diagnostic performance was evaluated via sensitivity, specificity, and area under the curve (AUC). Interobserver agreement was assessed with Cohen's kappa; correlation with CAC (Agatston score) used Spearman's rho. RESULTS: Breast arterial calcification was present in 17.8% (16/90) and showed a trend toward correlation with CAC (P = .05). The 4-level vessel count scale showed the strongest correlation with CAC (rho = 0.373; P <.001). The highest AUC (0.604) was achieved by the 4-level severity scale (sensitivity 44%, specificity 77%). Interobserver agreement was highest for the combined 4-level scale (κ = 0.835), followed by the 4-level vessel count (κ = 0.833), severity-only (κ = 0.819), 3-level vessel count (κ = 0.833), and the dichotomous scale (κ = 0.740). The dichotomous scale required the least time (mean 19 s/patient); the 3-level scale required the most (mean 51 s). The vessel count scale balanced accuracy, reproducibility, and efficiency (mean 34 s). CONCLUSION: Grading BACs is feasible, with consistently high interobserver agreement across scoring systems. The 4-level vessel count scale demonstrated a favorable balance of accuracy, reproducibility, and practicality, suggesting it may warrant further evaluation as a potential tool in mammography-based cardiovascular risk assessment.

Source: Journal of Breast Imaging

DOI: 10.1093/jbi/wbaf069