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 However, the evaluations of microcalcifications has be superceded by the use the the BI-RADS classification system, which has proven to be more accurate and detailed.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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