Can the absence of breast arterial calcifications on mammography predict the absence of coronary artery calcifications?

Abstract

Introduction: It has been suggested that breast arterial calcifications (BAC) on mammography predict coronary artery calcifications (CAC). However, it has been insufficiently addressed to rule out the presence of CAC. This study aimed to determine whether the absence of BAC on mammography is associated with the absence of CAC using the coronary computed tomography (CT) calcium score in women. Material and methods: This retrospective cross-sectional study included asymptomatic women who underwent digital screening mammography and coronary CT calcium score testing. BAC score was grouped into three categories: absence, intermediate, and significant. The Agatston score was used to quantify CAC. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of BAC were calculated to predict CAC. Results: We included 611 asymptomatic women with a mean age of 51.3 ± 8.37 years. The prevalence of BAC was 9.1% (n = 56), and CAC was 13.4% (n = 82). There was a significant association between the absence of BAC and no CAC (n = 501, 93.5%; p < 0.001). BAC diagnostic performance was stratified by age. In women under 60 years (n = 525), specificity was 94.6% (95% CI, 91.4-95.6), and the NPV 92.6% (95% CI, 91.4-95.6) for the absence of BAC in predicting no CAC. In women aged ≥ 60 years (n = 86), specificity was 82.6% (95% CI, 68.5-92.1), and the NPV was 60.3% (95% CI, 53.6-66.6). The sensitivity (14.2%, 95% CI, 16.1-35.05) and PPV (18.7%, 95% CI, 25.3-51.02) in women under 60 years were lower than in women ≥ 60 years with a sensitivity of 37.5% (95% CI, 22.7-54.2) and a PPV of 65.2% (95% CI, 47.0-79.8). Conclusion: The absence of BAC in screening mammography has the highest diagnostic performance for predicting the absence of CAC, especially in women under 60 years of age.