Microcalc's and cancelled biopsy... Thoughts???

amybeth4

I had a baseline mammo done on a Monday that resulted in me going back for a spot mag on Wednesday on the L breast. The report reads as follows:

The faint calcifications identified posteriorly in the left breast do persist with spot compression. These calcifications are very powdery in appearance and are grouped rather and tightly clustered (This is what it actually says in the report... sounds like something is missing).

Again noted is a surgical clip in the left breast. (I had microcalcs 5 years ago removed by core biopsy- benign).

There is no focal mass or area of architectural distortion on today's view.

The area of calcifications do not appear to layer out as milk of calcium. I have marked these on the left magnification mediolateral view. Needle localization and biopsy is recommended. On one of these magnification views there is suggestion of nodularity in the left breast but this does not persist as such with spot compression dedicated to the area of nodularity.

BI-RAD 4.

So, I go to have the core biopsy done on the cluster of microcalcs and after laying on the table "squished" for over an hour my surgeon tells me that he can't do the biopsy this way because they are so deep (next to the chest wall and midline to nipple). So, he goes to talk to the radiologist to show him my films and schedule a wire biopsy. He says that he is going to beg, borrow, plead, and promise him something really expensive to get it done ASAP. He comes back in after about 20 minutes and says the radiologist isn't even sure that he can do the wire guided biopsy on them, so we should just do a follow up mammo in 6 months to see if there are any changes since "most" of these are benign anyways. Should I be comfortable with that? I really am having a hard time processing that but don't know if maybe I am over-reacting since they seemed fine with it once they decided that tghey couldn't get to them. Initially it was a big rushing game to get me in and get this taken care of. "They HAD to come out" were the first radiologists words. Thanks for any input! (I wasn't really very worried initially since I have had microcalc's removed before that were B9 but as time goes by, I am getting very concerned. I am to go back in Nov for the 6 month f/u.)

cahjah75

I don't know what
to tell you. You're certainly getting mixed messages but I do know from my own stereostatic MRI assisted biopsy that they have to be able to get the wire to the site so they can take a biopsy. Yours is probably deeper that mine and mine wasn't behind the nipple. Talk to your oncologist/surgeon or whoever recommended the biopsy in the first place. I hope you get some answers soon. The waiting and worrying is the worse part!
{{hugs}} Char

carkris

cahjah75 said:

I don't know what
to tell you. You're certainly getting mixed messages but I do know from my own stereostatic MRI assisted biopsy that they have to be able to get the wire to the site so they can take a biopsy. Yours is probably deeper that mine and mine wasn't behind the nipple. Talk to your oncologist/surgeon or whoever recommended the biopsy in the first place. I hope you get some answers soon. The waiting and worrying is the worse part!
{{hugs}} Char

I would wonder why they dont
I would wonder why they dont biopsy it, if they would have if it was easier to get to. You may need to get a second opinion to be sure. many suspicious calcifications turn out benign, but how are you going to know? this is what would concern me.

Katz77

You sound like me
End of May 09 I had mammo,ultrasound and MRI of both breasts. Def very lg tumor 1200 high on right breast, Micros on left, many of them, scattered. A couple were to deep to biopsy. I had implants done almost 10 yr ago. He said even if implant wasn't there, they still were to deep. Now this was a breast center. Thats all they do. A couple of them "sizeable".
Ok jump to the present. Had mammo basically unchanged from a yr ago. Except more micros,small. I had IDC, HER2+, ER and PR positive, stage 3c and 18/20 positive nodes. Had mast done on right. SHOULD have done left also. Read or heard that micros can be positive, esp in aggressive cancers like me. The left boob is coming off Nov 8th. I'm sorry I don't know what cancer u have. Hopefully ur doc will be able to "pay off" the radiologist.
I told my onc what my plan was and he said" good idea". Most docs would try to talk you out of such drama. I see that is my sign. lol I'd get second opion if he or they are unwilling. Like I mentioned I don't know ur history. It's good you've had begign bf.
You said you don't want to seem "over reacting." No such thing when you have the diagnosis of cancer. Over react sister, over react. :)Best to you,Katz

fauxma

Amy Beth,
I would not wait 6
Amy Beth,
I would not wait 6 months for another mammo. That was what my sister was told and by then her cancer was a stage 3A or B with node involvement. Not wishing to worry you but they seemed in a hurry to do this until it became "too difficult to reach". If need be do a surgical biopsy to be sure it is nothing. Microcalcifications are often nothing but one of the indicators for cancer is when they are clustered and tightly together. I also thought that BiRad 4 is indicative of cancer. Doesn't mean it is but I think that BiRad 3 is when they are not sure and take a wait and see and 4 is biopsy. Again, this could be nothing but regular microcalcifications but why take a chance. If it is cancer and agressive who knows where it will be in 6 months. My prayers will be that this turns out fine and ultimately the decision is yours to make but I would not wait.
Stef

amybeth4

Thanks!
Thanks Ladies. I really am confused because as much as I want to just KNOW and get this over with, I hate the thoughts of over-reacting to what is "benign most of the time anyways." I have the odds on my side... Has anyone heard any statistics or something about microcalcifications recurring in a different area? Does that make them more probable/possible to be cancer?

swalters

Microcalcs and cancelled biopsy
Amybeth,

A lot of what you do with something like this depends on your comfort level and confidence in the radiologist handling this. After having a lumpectomy for DCIS in 2007, when I went in for my mammo in the fall of 2009, they thought they saw additional microcalcs on a magnification mammo and therefore wanted to do a stereotactic biopsy.

Since my doctor has recommended an MRI be done along with the yearly mammo, I had that done also. I chose to have an Aurora RODEO MRI because it has less than a 1 percent false negative rate. Nothing showed up on it, but the radiologist then did an ultrasound just to be sure, because of the questionable magnification mammo. She saw two additional areas of concern and recommended an additinal 2 biopsies.

I had just read an article by Dr.Laura Esserman about unnecessary biopsies. (You can find it online).I emailed her and asked how to tell which ones were unnecessary. She said to make sure that what they were seeing were actually new calcs and to ask the radiologist if the BIRAD-4 rating was a 4A. If it was, there was less than a 10 percent chance of malignancy.

I then consulted with Dr. Steven Harms, one of the most well-known radiologists in the country. After reviewing all my films, he agreed that since the RODEO MRI is the most sensitive of the 3 imaging technologies, it was unlikely that I needed 3 biopsies. He recommended I have another RODEO MRI in 6 months instead and reduced my BIRAD rating from a 5 (highly likely malignant) to 3(probably benign).

Last week I had that follow up 6 month MRI and he was right. The 3 biopsies were unnecessary. Although I had an area of atypical hyperplasia, I do not have any malignant cancer. Some would want even that atypical hyperplasia excised, but I am more concerned about being overbiopsied.

With all that I do for prevention,it is unlikely that I will ever have to deal with DCIS or anything more serious. However,everyone must make their own decisions. You must choose what is right for you.

If you would like any more info or have any question feel free to send me a PM.

Best wishes no matter what you decide,
Sandie

aj2016

Abnormal mammogram bi rad 4a
Hi please help
I had a mammogram that came back with bi rads 4a rating radiology report says a cluster of microcalcifications within the left upper outer quadrant they are not able to do a stereo static biopsy and surgical biopsy is recommended, these appear slightly more numerous then the previous mammogram done a year earlier and could not be included in the left cc views secondary to their posterior position, these microcalcifications are punctuate and round, slightly heterogenous in size no linear or branching forms are identified, on the lm magnification view there is a possible small macrobolated asymmetry, overall these calcifications span a region measuring 0.4 x 0.3 x 0.3 cm what are the chances this is cancer mammogram also states these breasts are extremely dense. Also how is a surgical biopsy done and what to expect I have tiny breasts to begin with. I am 36 no cancer in the family other than I am a smoker I am overall healthy, diagnosed with fybrosystic breasts last year. Cannot get in for a consult with a surgeon until July 19. Surgery seems so invasive but I don't want to play Russian roulette with my life either