Background Microcalcifications play a very important role in detection of breast cancer, especially early stagebreast cancer.However, ambiguity still exists in understanding the relationship between radiological andpathological characteristics of microcalcifications.The definitive indication of a biopsy has not been established.The purpose of this study is to evaluate the relationship of classification of breast microcalcifications using full-field digital mammography to the pathological characteristics.Methods For all the women an open biopsy had been conducted.One hundred and three mammographsshowing clustered microcalcifications from 98 consecutive patients were reviewed along with their pathologicalrecords.To investigate the value of each criterion for the detection of cancer, univariate and multivariate analyseswere performed on the entire sample and then on morphological subgroups.Results Pathological examination showed 67 malignant lesions (65.05%) and 36 benign lesions (34.95%).In the univariate analysis, four radiological variables were significant: morphological type (P=0.001),complicated by a mass (P=0.002), number of microcalcifications per cluster (P=0.02) and linear ortriangular distribution of clusters (P=0.009).In the multivariate analysis, two criteria remained significant:morphological type (P<0.001) and complicated by a mass (P=0.001).The percentage of malignancy was37.0%, 60.0%, 78.8%, and 88.9%, respectively, for type 2 (regularly punctiform), type 3 (dusty), type4 ( irregularly punctiform) and type 5 ( vermicular) microcalcifications ( Le Gal’s classification).Themalignancy was78.6% for microcalcifications complicated by a mass and 48.9% without a mass.The differencewas significant (P<0.05).The relationship between morphological types of microcalcifications and thepathological characteristics was also studied.In subgroups, type 3 (dusty) microcalcifications complicated by amass (P=0.001) or with the number of microcalcifications more than 10 (P=0.024); and type 2 (regularlypunctiform) with a diameter of the area over 20 mm (P=0.024) or complicated by a mass (P=0.025) werestatistically significant as criteria for malignant tumour.Conclusions Most cases of microcalcifications of type 4 or 5; type 3 complicated by a mass or with thenumber of microcalcifications more than 10; type 2 complicated by a mass or with a diameter of the area over20mm; are indicative of cancer.Open biopsy is recommended to acquire definitive pathological diagnosis for thesecases.For the remainder of the morphological types, stereotaxic biopsy or followup should be considered. Background Microcalcifications play a very important role in detection of breast cancer, especially early stagebreast cancer. Yet, ambiguity still exists in understanding the relationship between radiological andpathological characteristics of microcalcifications. Definitive indication of a biopsy has not been established.The purpose of this study. is to evaluate the relationship of classification of breast microcalcifications using full-field digital mammography to the pathological characteristics. Methods For all the women an open biopsy had been conducted. One hundred and three mammographshowing clustered microcalcifications from 98 consecutive patients were reviewed along with their pathologicalrecords .To investigate the value of each criterion for the detection of cancer, univariate and multivariate analyzeswere performed on the entire sample and then on morphological subgroups.Results Pathological examination showed 67 malignant lesions (65.05%) and 36 benign lesions (34.95%) . The univariate analysis of four radiological variables were significant: morphological type (P = 0.001), complicated by a mass (P = 0.002), number of microcalcifications per cluster (P = 0.02) and linear ortriangular distribution of clusters In the multivariate analysis, two percentage remained significant: morphological type (P <0.001) and complicated by a mass (P = 0.001). The percentage of malignancy was 37.0%, 60.0%, 78.8%, and 88.9%, respectively , for type 2 (regularly punctiform), type 3 (dusty), type 4 (irregularly punctiform) and type 5 (vermicular) microcalcifications (Le Gal’s classification) .Themalignancy was78.6% for microcalcifications complicated by a mass and 48.9% without a mass The difference between morphological types of microcalcifications and the pathological characteristics was also studied.In subgroups, type 3 (dusty) microcalcifications complicated by amass (P = 0.001) or with the number of microcalcifications more than 10(P= 0.024); and type 2 (regularpunctiform) with a diameter of the area over 20 mm (P = 0.024) or complicated by a mass (P = 0.025) were statistically significant for the criteria for malignant tumor. Conlusions Most cases of microcalcifications of type 4 type 3 complicated by a mass or with number of microcalcifications more than 10; type 2 complicated by a mass or with a diameter of the area over 20 mm; are indicative of cancer. Open biopsy is recommended to acquire definitive pathological diagnosis for thesecases. For the remainder of the morphological types, stereotaxic biopsy or followup should be considered.