Breast Radiology Reporting - 1st STU ballot
0.2.0 - STU 1 Ballot 2020May
Breast Radiology Reporting - 1st STU ballot
0.2.0 - STU 1 Ballot 2020May
Breast Radiology Reporting - 1st STU ballot - Local Development build (v0.2.0). See the Directory of published versions
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<CodeSystem xmlns="http://hl7.org/fhir"> <id value="MammoCalcificationTypeCS"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><h2>Mammography Calcification Type CodeSystem</h2><div><p>Mammography calcification type code system.</p> </div><p>This code system http://hl7.org/fhir/us/breast-radiology/CodeSystem/MammoCalcificationTypeCS defines the following codes:</p><table class="codes"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style="white-space:nowrap">Amorphous<a name="MammoCalcificationTypeCS-Amorphous"> </a></td><td>Amorphous</td><td>(historically, "indistinct") These are sufficiently small and/or hazy in appearance that a more specific particle shape cannot be determined. Amorphous calcifications in a grouped, linear, or segmental distribution are suspicious and generally warrant biopsy. Bilateral, diffuse amorphous calcifications usually may be dismissed as benign, although baseline magnification views may be helpful. The positive predictive value (PPV) of amorphous calcifications is reported to be approximately 20%. Therefore, calcifications of this morphology appropriately should be placed into BI-RADS assessment category 4B (PPV range > 10% to ? 50%). [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Coarse<a name="MammoCalcificationTypeCS-Coarse"> </a></td><td>Coarse</td><td>The classic large 'popcorn-like' calcifications are produced by involuting fibroadenomas. These calcifications usually do not cause a diagnostic problem. When the calcifications in an fibroadenoma are small and numerous, they may resemble malignant-type calcifications and need a biopsy. These are the classic large (> 2 to 3 mm in greatest diameter) calcifications produced by an involuting fibroadenoma. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Dystrophic<a name="MammoCalcificationTypeCS-Dystrophic"> </a></td><td>Dystrophic</td><td>Dystrophic soft tissue calcification is a broad term that encompasses a wide range of pathologies that cause soft-tissue calcification and is caused by calcification of damaged tissues. The amorphous calcification that results may be small or large. In some cases, ossification may occur - this is characterized by cortical formation and a central medullary cavity. [https://radiopaedia.org/articles/dystrophic-soft-tissue-calcification-1?lang=us] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Eggshell<a name="MammoCalcificationTypeCS-Eggshell"> </a></td><td>Eggshell</td><td>Eggshell calcifications in the breast are benign peripheral rim like calcifications They are typically secondary to fat necrosis or calcification of oil cysts. thin rim-like calcification (<1 mm in thickness) lucent centers small to several centimeters in diameter (oil cyst) may disappear (fat necrosis) [https://radiopaedia.org/articles/eggshell-calcification-breast-1?lang=us] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Fine<a name="MammoCalcificationTypeCS-Fine"> </a></td><td>Fine</td><td>These are thin, linear or curvilinear irregular calcifications and may be discontinuous. Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Generic<a name="MammoCalcificationTypeCS-Generic"> </a></td><td>Generic</td><td>Calcification happens when calcium builds up in body tissue, blood vessels, or organs. This buildup can harden and disrupt the body's normal processes. Calcium is transported through the bloodstream and is also found in every cell. As a result, calcification can occur in almost any part of the body. Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">CoarseHeterogeneous<a name="MammoCalcificationTypeCS-CoarseHeterogeneous"> </a></td><td>Coarse Heterogeneous</td><td>These are irregular, conspicuous calcifications that are generally between 0.5 mm and 1 mm and tend to coalesce, but are smaller than dystrophic calcifications. They may be associated with malignancy but more frequently are present in a fibroadenoma or in areas of fibrosis or trauma representing evolving dystrophic calcifications. Numerous bilateral groups of coarse heterogeneous calcifications usually may be dismissed as benign, although baseline magnification views may be helpful. However, a single group of coarse heterogeneous calcifications has a positive predictive value of slightly less than 15%, and therefore this finding should be placed in BI-RADS assessment category 4B (PPV range > 10% to ? 50%). [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Indistinct<a name="MammoCalcificationTypeCS-Indistinct"> </a></td><td>Indistinct</td><td>Amorphous calcifications, previously known as indistinct calcifications, are a morphological descriptor for breast calcifications that are small and/or hazy such that no clearly defined shape/form can be ascribed. [https://radiopaedia.org > articles > amorphous-calcifications-breast] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">LargeRodlike<a name="MammoCalcificationTypeCS-LargeRodlike"> </a></td><td>Large rodlike</td><td>These benign calcifications associated with ductal ectasia may form solid or discontinuous smooth linear rods, most of which are 0.5 mm or larger in diameter. A small percentage of these calcifications may have lucent centers if the calcium is in the wall of the duct (periductal), but most are intraductal, when calcification forms within the lumen of the duct. All large rod-like calcifications follow a ductal distribution, radiating toward the nipple, occasionally branching. The calcifications usually are bilateral, although they may be seen in only one breast, especially when few calcific particles are visible. These calcifications usually are seen in women older than 60 years. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Layering<a name="MammoCalcificationTypeCS-Layering"> </a></td><td>Layering</td><td>Layering of calcium within the calcification. [https://radiologyassistant.nl/breast/breast-calcifications-differential-diagnosis] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">FineLinear<a name="MammoCalcificationTypeCS-FineLinear"> </a></td><td>Fine Linear</td><td>Also called fine linear branching. These are thin, linear, irregular calcifications, which may be discontinuous and which are smaller than 0.5 mm in caliber. Occasionally, branching forms may be seen. Their appearance suggests filling of the lumen of a duct or ducts involved irregularly by breast cancer. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition page 66] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Lucent-centered<a name="MammoCalcificationTypeCS-Lucent-centered"> </a></td><td>Lucent-centered</td><td>These are round or oval calcifications that range from under 1 mm to over a centimeter. They are the result of fat necrosis, calcified debris in ducts, and occasional fibroadenomas. [https://radiologyassistant.nl/breast/breast-calcifications-differential-diagnosis] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">MilkOfCalcium<a name="MammoCalcificationTypeCS-MilkOfCalcium"> </a></td><td>Milk of calcium</td><td>This is a manifestation of sedimented calcifications in macro- or microcysts, usually but not always grouped. On the craniocaudal image they are often less evident and appear as round, smudgy deposits, while occasionally on MLO and especially on 90 lateral (LM/ML) views, they are more clearly defined and often semilunar, crescent shaped, curvilinear (concave up), or linear, defining the dependent portion of cysts. The most important feature of these calcifications is the apparent change in shape of the calcific particles on different mammographic projections (craniocaudal versus occasionally the MLO view and especially LM/ML views). At times milk of calcium calcifications are seen adjacent to other types of calcifications that may be associated with malignancy, so it is important to search for more suspicious forms, especially those that do not change shape from the 90 lateral projection to the CC projection. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">FinePleomorphic<a name="MammoCalcificationTypeCS-FinePleomorphic"> </a></td><td>Fine Pleomorphic</td><td>These calcifications are usually more conspicuous than amorphous forms and are seen to have discrete shapes. These irregular calcifications are distinguished from fine linear and fine-linear branching forms by the absence of fine-linear particles. Fine pleomorphic calcifications vary in size and shape and are usually smaller than 0.5 mm in diameter. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition page 64] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Punctate<a name="MammoCalcificationTypeCS-Punctate"> </a></td><td>Punctate</td><td>Calcification is punctate/round. It's different than a "round" calcification though as it also means the calcifications are less than .5 mm in size. May warrant a probably benign (non-cancer) assessment unless there is also a linear pattern or in a segmental distibution. This may require and imaging guided biopy or mammographic surveillance. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Rim<a name="MammoCalcificationTypeCS-Rim"> </a></td><td>Rim</td><td>Eggshell or Rim Calcifications These are very thin benign calcifications that appear as calcium is deposited on the surface of a sphere. Fat necrosis and calcifications in the walls of cysts are the most common "rim" calcifications, although more extensive (and occasionally thicker-rimmed) calcification in the walls of oil cysts or simple cysts may be seen. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition page 49] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Round<a name="MammoCalcificationTypeCS-Round"> </a></td><td>Round</td><td>When multiple, they may vary in size and therefore also in opacity. They may be considered benign when diffuse and small (< 1 mm), and are frequently formed in the acini of lobules. When smaller than 0.5 mm, the term "punctate" should be used. An isolated group of punctate calcifications may warrant probably benign assessment and mammographic surveillance if no prior examinations are available for comparison, or image-guided biopsy if the group is new, increasing, linear or segmental in distribution, or if adjacent to a known cancer. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Skin<a name="MammoCalcificationTypeCS-Skin"> </a></td><td>Skin</td><td>These are usually lucent-centered and pathognomonic in their appearance. Skin calcifications are most commonly seen along the inframammary fold, parasternally, overlying the axilla and around the areola. The individual calcific particles usually are tightly grouped, with individual groups smaller than 5 mm in greatest dimension. Skin calcifications may develop from a degenerative metaplastic process. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition page 36] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Spherical<a name="MammoCalcificationTypeCS-Spherical"> </a></td><td>Spherical</td><td>Calcifications that have formed a spherical shape are usually associated with benign lesions. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Suture<a name="MammoCalcificationTypeCS-Suture"> </a></td><td>Suture</td><td>Calcified suture materials are typically linear or tubular in appearance, and when present in Mammogram, may show up in a knot pattern. Valid for the following modalities: MG.</td></tr><tr><td style="white-space:nowrap">Vascular<a name="MammoCalcificationTypeCS-Vascular"> </a></td><td>Vascular</td><td>These are linear or form parallel tracks, that are usually clearly associated with blood vessels. Vascular calcifications noted in women On the left typical vascular calcifications. If only one side of a vessel is calcified, the calcification may simulate intraductal (across a group of milk ducts) calcification. [https://radiologyassistant.nl/breast/breast-calcifications-differential-diagnosis] Valid for the following modalities: MG.</td></tr></table></div> </text> <url value="http://hl7.org/fhir/us/breast-radiology/CodeSystem/MammoCalcificationTypeCS"/> <version value="0.2.0"/> <name value="MammoCalcificationTypeCS"/> <title value="Mammography Calcification Type CodeSystem"/> <status value="draft"/> <date value="2019-11-01T00:00:00+00:00"/> <publisher value="Hl7 - Clinical Interoperability Council"/> <contact> <telecom> <system value="url"/> <value value="http://hl7.org/Special/committees/cic"/> </telecom> </contact> <description value="Mammography calcification type code system."/> <jurisdiction> <coding> <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/> <code value="001"/> </coding> </jurisdiction> <caseSensitive value="true"/> <content value="complete"/> <count value="21"/> <concept> <code value="Amorphous"/> <display value="Amorphous"/> <definition value="(historically, "indistinct") These are sufficiently small and/or hazy in appearance that a more specific particle shape cannot be determined. Amorphous calcifications in a grouped, linear, or segmental distribution are suspicious and generally warrant biopsy. Bilateral, diffuse amorphous calcifications usually may be dismissed as benign, although baseline magnification views may be helpful. The positive predictive value (PPV) of amorphous calcifications is reported to be approximately 20%. Therefore, calcifications of this morphology appropriately should be placed into BI-RADS assessment category 4B (PPV range > 10% to ? 50%). [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG."/> </concept> <concept> <code value="Coarse"/> <display value="Coarse"/> <definition value="The classic large 'popcorn-like' calcifications are produced by involuting fibroadenomas. These calcifications usually do not cause a diagnostic problem. When the calcifications in an fibroadenoma are small and numerous, they may resemble malignant-type calcifications and need a biopsy. These are the classic large (> 2 to 3 mm in greatest diameter) calcifications produced by an involuting fibroadenoma. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG."/> </concept> <concept> <code value="Dystrophic"/> <display value="Dystrophic"/> <definition value="Dystrophic soft tissue calcification is a broad term that encompasses a wide range of pathologies that cause soft-tissue calcification and is caused by calcification of damaged tissues. The amorphous calcification that results may be small or large. In some cases, ossification may occur - this is characterized by cortical formation and a central medullary cavity. [https://radiopaedia.org/articles/dystrophic-soft-tissue-calcification-1?lang=us] Valid for the following modalities: MG."/> </concept> <concept> <code value="Eggshell"/> <display value="Eggshell"/> <definition value="Eggshell calcifications in the breast are benign peripheral rim like calcifications They are typically secondary to fat necrosis or calcification of oil cysts. thin rim-like calcification (<1 mm in thickness) lucent centers small to several centimeters in diameter (oil cyst) may disappear (fat necrosis) [https://radiopaedia.org/articles/eggshell-calcification-breast-1?lang=us] Valid for the following modalities: MG."/> </concept> <concept> <code value="Fine"/> <display value="Fine"/> <definition value="These are thin, linear or curvilinear irregular calcifications and may be discontinuous. Valid for the following modalities: MG."/> </concept> <concept> <code value="Generic"/> <display value="Generic"/> <definition value="Calcification happens when calcium builds up in body tissue, blood vessels, or organs. This buildup can harden and disrupt the body's normal processes. Calcium is transported through the bloodstream and is also found in every cell. As a result, calcification can occur in almost any part of the body. Valid for the following modalities: MG."/> </concept> <concept> <code value="CoarseHeterogeneous"/> <display value="Coarse Heterogeneous"/> <definition value="These are irregular, conspicuous calcifications that are generally between 0.5 mm and 1 mm and tend to coalesce, but are smaller than dystrophic calcifications. They may be associated with malignancy but more frequently are present in a fibroadenoma or in areas of fibrosis or trauma representing evolving dystrophic calcifications. Numerous bilateral groups of coarse heterogeneous calcifications usually may be dismissed as benign, although baseline magnification views may be helpful. However, a single group of coarse heterogeneous calcifications has a positive predictive value of slightly less than 15%, and therefore this finding should be placed in BI-RADS assessment category 4B (PPV range > 10% to ? 50%). [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG."/> </concept> <concept> <code value="Indistinct"/> <display value="Indistinct"/> <definition value="Amorphous calcifications, previously known as indistinct calcifications, are a morphological descriptor for breast calcifications that are small and/or hazy such that no clearly defined shape/form can be ascribed. [https://radiopaedia.org > articles > amorphous-calcifications-breast] Valid for the following modalities: MG."/> </concept> <concept> <code value="LargeRodlike"/> <display value="Large rodlike"/> <definition value="These benign calcifications associated with ductal ectasia may form solid or discontinuous smooth linear rods, most of which are 0.5 mm or larger in diameter. A small percentage of these calcifications may have lucent centers if the calcium is in the wall of the duct (periductal), but most are intraductal, when calcification forms within the lumen of the duct. All large rod-like calcifications follow a ductal distribution, radiating toward the nipple, occasionally branching. The calcifications usually are bilateral, although they may be seen in only one breast, especially when few calcific particles are visible. These calcifications usually are seen in women older than 60 years. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG."/> </concept> <concept> <code value="Layering"/> <display value="Layering"/> <definition value="Layering of calcium within the calcification. [https://radiologyassistant.nl/breast/breast-calcifications-differential-diagnosis] Valid for the following modalities: MG."/> </concept> <concept> <code value="FineLinear"/> <display value="Fine Linear"/> <definition value="Also called fine linear branching. These are thin, linear, irregular calcifications, which may be discontinuous and which are smaller than 0.5 mm in caliber. Occasionally, branching forms may be seen. Their appearance suggests filling of the lumen of a duct or ducts involved irregularly by breast cancer. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition page 66] Valid for the following modalities: MG."/> </concept> <concept> <code value="Lucent-centered"/> <display value="Lucent-centered"/> <definition value="These are round or oval calcifications that range from under 1 mm to over a centimeter. They are the result of fat necrosis, calcified debris in ducts, and occasional fibroadenomas. [https://radiologyassistant.nl/breast/breast-calcifications-differential-diagnosis] Valid for the following modalities: MG."/> </concept> <concept> <code value="MilkOfCalcium"/> <display value="Milk of calcium"/> <definition value="This is a manifestation of sedimented calcifications in macro- or microcysts, usually but not always grouped. On the craniocaudal image they are often less evident and appear as round, smudgy deposits, while occasionally on MLO and especially on 90 lateral (LM/ML) views, they are more clearly defined and often semilunar, crescent shaped, curvilinear (concave up), or linear, defining the dependent portion of cysts. The most important feature of these calcifications is the apparent change in shape of the calcific particles on different mammographic projections (craniocaudal versus occasionally the MLO view and especially LM/ML views). At times milk of calcium calcifications are seen adjacent to other types of calcifications that may be associated with malignancy, so it is important to search for more suspicious forms, especially those that do not change shape from the 90 lateral projection to the CC projection. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG."/> </concept> <concept> <code value="FinePleomorphic"/> <display value="Fine Pleomorphic"/> <definition value="These calcifications are usually more conspicuous than amorphous forms and are seen to have discrete shapes. These irregular calcifications are distinguished from fine linear and fine-linear branching forms by the absence of fine-linear particles. Fine pleomorphic calcifications vary in size and shape and are usually smaller than 0.5 mm in diameter. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition page 64] Valid for the following modalities: MG."/> </concept> <concept> <code value="Punctate"/> <display value="Punctate"/> <definition value="Calcification is punctate/round. It's different than a "round" calcification though as it also means the calcifications are less than .5 mm in size. May warrant a probably benign (non-cancer) assessment unless there is also a linear pattern or in a segmental distibution. This may require and imaging guided biopy or mammographic surveillance. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG."/> </concept> <concept> <code value="Rim"/> <display value="Rim"/> <definition value="Eggshell or Rim Calcifications These are very thin benign calcifications that appear as calcium is deposited on the surface of a sphere. Fat necrosis and calcifications in the walls of cysts are the most common "rim" calcifications, although more extensive (and occasionally thicker-rimmed) calcification in the walls of oil cysts or simple cysts may be seen. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition page 49] Valid for the following modalities: MG."/> </concept> <concept> <code value="Round"/> <display value="Round"/> <definition value="When multiple, they may vary in size and therefore also in opacity. They may be considered benign when diffuse and small (< 1 mm), and are frequently formed in the acini of lobules. When smaller than 0.5 mm, the term "punctate" should be used. An isolated group of punctate calcifications may warrant probably benign assessment and mammographic surveillance if no prior examinations are available for comparison, or image-guided biopsy if the group is new, increasing, linear or segmental in distribution, or if adjacent to a known cancer. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG."/> </concept> <concept> <code value="Skin"/> <display value="Skin"/> <definition value="These are usually lucent-centered and pathognomonic in their appearance. Skin calcifications are most commonly seen along the inframammary fold, parasternally, overlying the axilla and around the areola. The individual calcific particles usually are tightly grouped, with individual groups smaller than 5 mm in greatest dimension. Skin calcifications may develop from a degenerative metaplastic process. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition page 36] Valid for the following modalities: MG."/> </concept> <concept> <code value="Spherical"/> <display value="Spherical"/> <definition value="Calcifications that have formed a spherical shape are usually associated with benign lesions. [Breast Imaging Reporting and Data System—Ultrasound, Second Edition] Valid for the following modalities: MG."/> </concept> <concept> <code value="Suture"/> <display value="Suture"/> <definition value="Calcified suture materials are typically linear or tubular in appearance, and when present in Mammogram, may show up in a knot pattern. Valid for the following modalities: MG."/> </concept> <concept> <code value="Vascular"/> <display value="Vascular"/> <definition value="These are linear or form parallel tracks, that are usually clearly associated with blood vessels. Vascular calcifications noted in women On the left typical vascular calcifications. If only one side of a vessel is calcified, the calcification may simulate intraductal (across a group of milk ducts) calcification. [https://radiologyassistant.nl/breast/breast-calcifications-differential-diagnosis] Valid for the following modalities: MG."/> </concept> </CodeSystem>
IG © 2019+ Hl7 - Clinical Interoperability Council. Package hl7.fhir.us.breast-radiology#0.2.0 based on FHIR 4.0.1. Generated 2020-04-07
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