Birads3 - grouped microcalcifications

Rsin

Hi everyone

I am 40 with no family history. Went for my first screening mammo and was asked to come back for a diagnostic on right breast. Left breast had benign findings - scattered microcalcifications. Diagnostic mammogram on right breast showed a group of round microcalcifications over 2cm area and was reported as BI-RADS 3. I am very worriedand planning to get second opinion and even a biopsy. My PCP thinks it's nothing to worry about and just do the follow up in 6 months.

sorry for the long post. I really Appreciate any inputs I can receive here. Thank you so much.

Beesie

A BIRADs 3 means the Radiologist assesses less than a 2% chance of cancer.

Round calcifications are more likely to be benign. The fact that they are clustered is probably what is bumping you up from a BIRADs 2 to a BIRADs 3, but with the calcs being over a 2 cm area, it suggests that this is not a tight cluster, so again that leans towards benign.

Normal follow-up for a BIRADs 3 is imaging in 6 months. The purpose of the follow-up is to assess stability, in which case a biopsy can be avoided. I've had lots of BIRADs 4s and lot of BIRADs 3s, and I've always been happy to get the 3s so that I could avoid a biopsy. None of my BIRADs 3 have ever required a biopsy upon follow-up.

If you are uncomfortable, a second opinion on your imaging will be helpful. If the assessment is the same, you can feel better about the recommendation to follow-up in 6 months. If the assessment is different, you can proceed with a biopsy now.

Rsin

thank you Beesie for your response. I will move forward with getting second opinion.

DATNY

I did have that. Followed it for two years and they were stable. Than a year later, my annual screening found multiple tumors (at other places, but same breast) including one in a lymph node. So my conclusion was they were some sort of warning sign in my case. In general, calcifications appear because there are processes taking place at a faster rate than they should be.

I regreted not doing a biopsy initially. Not sure it is possible with Brads 3 , I never asked.

djmammo

DATNY

"In general, calcifications appear because there are processes taking place at a faster rate than they should be."

Can you direct me to a reference for this? Thanks.

Rsin

Datny - did you have scattered or grouped loosely? Were they round as well? Thank you

Rsin

It is taking forever to get a second opinion and the waiting is not helping my anxiety.

DjMammo, will you be able to offer any kind of insight on why the type of calcifications I have are probably benign and not totally benign. Are they lobular? Does DCIS look like this as well? What are the chances of this turning invasive (if malignant) during the 6 month waiting period?

From Report -

CLINICAL HISTORY: Callback.

BREAST DENSITY: The breasts are heterogeneously dense, which may obscure small masses.

RIGHT BREAST DIGITAL MAMMOGRAPHY FINDINGS: 2 cm area of grouped round calcifications seen within the 7:00 location of the right breast 6 cm from the nipple. These calcifications have a probably benign appearance.

IMPRESSION: BI-RADS Category 3-Probably Benign Findings.

RECOMMENDATION: Six-month follow up is recommended. Right diagnostic mammogram in six months with magnification views recommended.

djmammo

Rsingh1

Grouped round calcifications have a higher probability of being benign than other shapes (and grouped is better than clustered).

Classically, DCIS is described as "linear branching" calcifications.

B3 indicates a 98% chance they are benign

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Rsin

DJMammo - Very much appreciate your quick response. Thank you!

Rsin

djmammo

I decided to move forward with a biopsy and not wait in anxiety for another 6 months. The results came back benign. I am yet to go over the results with my breast surgeon. Here is the final diagnosis. Can you please help me understand the report. Are any of these re risk factors for breast cancer?

From the report-

Negative for malignancy.

Proliferative fibrocystic change.

Pseudoangiomatous stromal hyperplasia.

Small Intraducal papilloma

Columnar cell change with hyperplasia.

Calcifications identified.

Thank you again for your time and help.

djmammo

Rsin

Negative for malignancy. - Great!

Proliferative fibrocystic change - benign

Pseudoangiomatous stromal hyperplasia - PASH

Small Intraducal papilloma - if the entire papilloma is not completely included in the specimen, it will have to be removed

Columnar cell change with hyperplasia - see this explanation: https://breast-cancer.ca/clmncellesions/

Calcifications identified - must be benign type calcs

Rsin

Thank you for your response, djmammo.

Does "columnar cell change with hyperplasia" possess any risk? Also, why is it recommended to remove the papilloma?