Le Gal Classifications of microcalcifications

The “Le-Gal” classifications system for microcalcifications originated in France in the early 1980s, and is still used in that country. However, the evaluations of microcalcifications has be superceded by the use the the BI-RADS classification system, which has proven to be more accurate and detailed.

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Le Gal breast classifications according to five types

Type 1: Ring-shaped, arciform or sausage like, so called “teacup” microcalcifications viewed by a true lateral. Lobular localization is due to the sedimentation of milk of calcium in the micro cysts or in the ectatic ducts. Virtually no risk for breast cancer.
Type 2: Round microcalcifications, punctate, of variable size, but with regular contours. Possibly grouped in small bunches with round topographic distribution, sometimes side by side like diplococcus but commonly disseminated in both breasts. Usually benign and of the lobular type. Malignancy rate is thought to be 15-22 percent.
Type 3: Pulverulent, dusty microcalcifications, too fine to be counted. Malignancy rate is around 40%.
Type 4: Punctate or granular microcalcifications with irregular contours, often with pleomorphism. The contours are typically angular, polyhedral, and with a triangular, angular topographic distribution (trapezoid, butterfly wing,rectangular, square). Risk of breast cancer is around 60%. Malignant microcalcifications are generally intraductal. If benign, the microcalcifications were in the microcysts, or the interstitium.
Type 5: Vermicular (linear) microcalcifications, with ramification and branching patterns, with galactophorous orientation, and angular or segmental or topographic distribution. They are examples of ductal necrosis and are very likely to be malignant, at about 95% of the time.

Neither system is accurate and specific enough to forego biopsy or additional imaging for confirmation

A few comparitive studies have been done testing the senstivity and accuracy of both BI-RADS and Le Gal classifications of breast microcalcifications. Only category 5 breast lesions show a slight advantage in positive predictive value for the Le Gal classications. On the whole both systems have about the same sensitivity, but BI-RADS classifications have shown to have a slightly higher positive predictive value and accuracy for the identification of breast cancer overall. But neither classification system is ‘non-ambiguous‘ enough to forego additional imaging or biopsy for a definitive diagnosis.

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References

1. Le Gal, M., Chavanne, G., Pellier, D. (1984). Diagnostic value of clustered microcalcifications discovered by mammography(apropos of 227 cases with histopathological verification and without a palpable breast tumor). Bull cancer; 71(1):57-64.
2. La Lettre du Médecin Radiologue, no 361, Juillet 2001, Fédération Nationale des Médecins Radiologues (FNMR), France.
3. Le Treut A, Barreau B, Kind M, Dilhuydy MH. Les microcalcifications mammaires, Journal de Radiologie, 1992, t. 73, no 10 : 527-541
4. Karahaliou A, Skiadopoulos S, Boniatis I, Sakellaropoulos P, Likaki E, Panayiotakis G, Costaridou L. Texture analysis of tissue surrounding microcalcifications on mammograms for breast cancer diagnosis. Br J Radiol. (Aug. 2007) 80(956):648-56.
5. Kim, JK., Park, JM., Song, KS., Park, HW. Texture analysis and artificial neural network for detection of clustered microcalcifications on mammograms. Neural Networks for Signal Processing [1997] VII. Proceedings of the 1997 IEEE Workshop (Sept. 1997)
6. Wei L, Yang Y, Nishikawa RM.Microcalcification classification assisted by content-based image retrieval for breast cancer diagnosis.Pattern Recognit. (June 2009);42(6):1126-1132.
7. Knutzen AM, Gisvold JJ. Likelihood of malignant disease for various categories of mammographically detected, nonpalpable breast lesions. Mayo Clin Proc. 1993;68:454– 460.
8. Travade, A., Isnard, A., Bagard, C., Bouchet, F. Malignancy in ACR 3 category mammographic lesions, masses and calcifications.Journal de Radiologie Volume 85, Issue 12 II, December 2004, Pages 2111-2122
9. Breast imaging reporting and data system (BI-RADS). American College of Radiology 1998.
10. Monsees BS. Evaluation of breast microcalcifications. Radiol Clin North Am 1995;33:1109-1121.
11. Fondrinier E, Lorimier G, Guerin-Boblet V, et al. Breast microcalcifications: multivariate analysis of radioologicaland clinical factors for carcinoma. World J Surg 2002;26:290-296.
12. Evans A, James J, Pinder S. Mammographic casting-type calcification associated with small screen-detected invasive breast cancers: is this a reliable prognostic indicator? Clinical Radiology 2004;59:163-164.
13. Resende LM, Matias MA, Oliveira GM, Salles MA, Melo FH, Gobbi H. Evaluation of breast microcalcifications according to Breast Imaging Reporting and Data System (BI-RADS) and Le Gal’s classifications. Rev Bras Ginecol Obstet. (Feb. 2008) 30(2):75-9.
14. Gulsun, M., Demirkazik, FB., Anyurek, M. Evaluation of breast microcalcifications according to breast imaging reporting and data system criteria and Le Gal’s classification, European Journal of Radiology, (Sept. 2003) Volume 47, Issue 3, Pages 227-231.

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