Breast Radiology Reporting - 1st STU ballot
0.2.0 - STU 1 Ballot 2020May

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Mammography Calcification Type ValueSet

Summary

Defining URL:http://hl7.org/fhir/us/breast-radiology/ValueSet/MammoCalcificationTypeVS
Version:0.2.0
Name:MammoCalcificationTypeVS
Status:draft
Title:Mammography Calcification Type ValueSet
Definition:

Mammography calcification types value set.

Publisher:Hl7 - Clinical Interoperability Council
Source Resource:XML / JSON / Turtle

References

Content Logical Definition

Definition

  • Include these codes as defined in http://hl7.org/fhir/us/breast-radiology/CodeSystem/MammoCalcificationTypeCS
    CodeDisplay
    AmorphousAmorphous(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.
    CoarseCoarseThe 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.
    DystrophicDystrophicDystrophic 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.
    EggshellEggshellEggshell 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.
    FineFineThese are thin, linear or curvilinear irregular calcifications
    and may be discontinuous.


    Valid for the following modalities: MG.
    GenericGenericCalcification 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.
    CoarseHeterogeneousCoarse HeterogeneousThese 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.
    IndistinctIndistinctAmorphous 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.
    LargeRodlikeLarge rodlikeThese 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.
    LayeringLayeringLayering of calcium within the calcification.
    [https://radiologyassistant.nl/breast/breast-calcifications-differential-diagnosis]

    Valid for the following modalities: MG.
    FineLinearFine LinearAlso 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.
    Lucent-centeredLucent-centeredThese 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.
    MilkOfCalciumMilk of calciumThis 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.
    FinePleomorphicFine PleomorphicThese 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.
    PunctatePunctateCalcification 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.
    RimRimEggshell 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.
    RoundRoundWhen 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.
    SkinSkinThese 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.
    SphericalSphericalCalcifications 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.
    SutureSutureCalcified 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.
    VascularVascularThese 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.

 

Expansion

This value set contains 21 concepts

Expansion based on http://hl7.org/fhir/us/breast-radiology/CodeSystem/MammoCalcificationTypeCS version 0.2.0

All codes from system http://hl7.org/fhir/us/breast-radiology/CodeSystem/MammoCalcificationTypeCS

CodeDisplayDefinition
AmorphousAmorphous(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.
CoarseCoarseThe 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.
DystrophicDystrophicDystrophic 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.
EggshellEggshellEggshell 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.
FineFineThese are thin, linear or curvilinear irregular calcifications and may be discontinuous. Valid for the following modalities: MG.
GenericGenericCalcification 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.
CoarseHeterogeneousCoarse HeterogeneousThese 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.
IndistinctIndistinctAmorphous 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.
LargeRodlikeLarge rodlikeThese 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.
LayeringLayeringLayering of calcium within the calcification. [https://radiologyassistant.nl/breast/breast-calcifications-differential-diagnosis] Valid for the following modalities: MG.
FineLinearFine LinearAlso 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.
Lucent-centeredLucent-centeredThese 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.
MilkOfCalciumMilk of calciumThis 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.
FinePleomorphicFine PleomorphicThese 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.
PunctatePunctateCalcification 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.
RimRimEggshell 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.
RoundRoundWhen 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.
SkinSkinThese 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.
SphericalSphericalCalcifications 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.
SutureSutureCalcified 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.
VascularVascularThese 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.

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
Source The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code