Certain calcification patterns are almost always pathognomic of a benign process, and in such cases no further analysis is needed. In the majority of cases, however, a pattern of calcification deposition is inconclusive and may be attributable to either a benign or malignant process. Needless to say, these cases require additional evaluation such as using magnification mammography to further elucidate the calcifications' morphology and distribution. Size Generally speaking, microcalcifications are associated with a malignant process and macrocalcifications are associated with a benign process. The problem with this general rule is that there is no fine line of measurement that could enable one to distinguish between micro and macro.
All calcifications start out imperceptably small and radiographically invisible.
The smallest visible calcifications on a mammogram is approximately 0.2 - 0.3 mm. The number of calcifications that make up a cluster has been used as an indicator of benign and malignancy. While the actual number itself is arbitrary, radiologists tend to agree that the minimum number of calcifications be either four, five, or six to be of significance. Any number of calcifications less than four will rarely lead to the detection of breast cancer in and of itself. Again, as with all criteria in mammographic analysis, no number is absolute and two or three calcifications may merit greater suspicion if they exhibit worrisome morphologies.