Change in micro-calcifications

JenInNY

Hi,

I’m having stereotactic biopsies tomorrow of two different sites on the right breast. I gotta say, I’m a wreck.

After a slightly late 6 month diagnostic mammo, they found that the original grouped calcifications increased in number, are fine pleomorphic in character and ‘suggestion of associated focal asymmetry is observed’. There was an additional finding of a “new benign-appearing relatively loose grouping of several rounded calcifications in the central posterior right breast”. The original grouping is at 9:00 axis of posterior right breast, so both groupings are close.

The recommendation for the new finding was 6 month follow-up mammo, but I requested a biopsy since they were doing the other one anyway. I see no point in leaving it to worry.

The original grouping at 9:00 had shown up once before in 2016. I was told it was entirely removed during stereotactic biopsy and found to be benign. I’m concerned that it’s returned in the same place and that it has changed/increased in the 8 months since it was discovered again. I am 47 w/very dense breasts and my mom had DCIS at 49.

I’m not sure if I should contact a breast surgeon of office the radiologist is good enough. I don’t have the best confidence with this breast center

I’m also VERY curious to know if they do a “wet read” (frozen section) during the procedure in the event that it’s obviously a malignancy? My primary had the impression that they do and to be prepared for a potential lumpectomy/surgical biopsy same day? Is this common?

My report says DIFFERENTIAL DX: sclerosing adenosis and DCIS.

BIRADS 4: Suspicious for malignancy; biopsy should be considered.

ANY insight would be greatly appreciated.

I am a very info-needed kind of person. The unknown scares me. The good, the bad. I need info. Please. I just need to know the possibilities

Thank you

~jen

Beesie

So sorry you are going through this.

To your questions:

"I'm not sure if I should contact a breast surgeon of office the radiologist is good enough"

- Actually, a Radiologist is the expert at doing stereotactic biopsies. It's not something most surgeons would do. So for now you are in the right place.

"I'm also VERY curious to know if they do a "wet read" (frozen section) during the procedure in the event that it's obviously a malignancy? My primary had the impression that they do and to be prepared for a potential lumpectomy/surgical biopsy same day? Is this common?"

- I've been hanging around here for over 13 years and I don't know if I've ever seen a situation where someone was sent straight from a core needle biopsy (stereotactic or ultrasound or MRI) into surgery. It's a completely different procedure, with different preparatory requirements and with different doctors. So no, it's definitely not common and I don't know if it ever happens at all. As for reading the sample immediately, this is sometimes done just to ensure that the sample has picked up the calcifications, but as a way to get the biopsy results quickly, while the procedure is underway? Nope.

The thing with most cases of breast cancer, and particularly DCIS or early stage invasive cancer (which seem to be the most likely possibilities if your biopsy is positive) is that it is not a medical emergency. So there is no need to do these sorts of things that rush the process and don't give you time to pick your surgeon and decide on your preferred course of treatment.

Good luck with the biopsy! Hopefully the results are benign.

blah333

clusters of calcifications are usually associated with DCIS. I don't think doing a "wet read" so they can give you a lumpectomy right then and there is common. Usually women want to know more information, such as genetic testing or get an MRI. Sometimes the DCIS is multi-focal so removing just that cluster doesn't remove it all. When I had my biopsy I had to get a mammogram afterwards to make sure that the clip was placed properly, and that nurse called the radiologist in the other room on speaker phone and I could hear her say "what lovely specimens!" almost like she was excited to see my DCIS. So they probably do take a look of some kind before sending it off for the official results.

Sorry you don't have confidence in the radiologists. The first resident who did my initial diagnosis was great, but since then I've had to have biopsies in my lymph nodes (arm pit) Fine Needle Aspiration and that is tough and tedious, the first time they grabbed muscle tissue and I had to redo it again (and wait another month). It was stressful and at the re-do they decided to biopsy a different node. So idiotic. ANYWAY despite that, the radiologist should be competent enough to grab samples to see if things are malignant or not. Because you are testing two different spots it doesn't make sense to jump ahead to a breast surgeon until more information is gathered. Not to make you worry more -- but if things end up being more extensive than initially written up, no use in going through two lumpectomies then a mastectomy, or two lumpectomies then two redos to get better margins. Stereostatic biopsies are much less invasive and will get the info you need to know. Hang in there. Biopsy stress is the absolute worst.

HH25

Our situations are very similar. I’m 48 and I had two spots of DCIS on the left side. I had a stereo tactic vacuum assisted biopsy and developed a hematoma so I had to wait for surgery. My partial mastectomy was yesterday and 3 lymph nodes lit up so the surgeon took those out too. I’m hoping to get my results tomorrow. Keep in touch and I’m sorry you’re dealing with this.

Frenchiegal83

@JeninNY, did you find out anything from your biopsies? From your history, it sounds a lot like mine. I'm having a biopsy next Tuesday on some calcifications. Per my mammogram report "The upper left breast demonstrates focus of pleomorphic calcifications increased compared to previous. Magnification views confirm clustered mildly pleomorphic nature. Given progression, clustering, and mild pleomorphism, further assessment is recommended with biopsy." So just over here, researching all the things that are associated with these changes. I have a long history of fibroadenomas (I think basically that's all that's in my breasts ) so having biopsies isn't new, but this whole calcification thing is new to me and from what I've read, these pleomorphic changes isn't good. It's def not a done deal yet, but def. has me worried. Hope you received good news!

JenInNY

Hi FrenchieGal!,

So, I'm about 1 month post lumpectomy w/3 seed localizations. I've had a total of 4 biopsies between January 2020 and May 2020 and too many imaging studies to count/remember. 3 stereotactic core biopsies and 1 MRI guided VAB. While I ended up with a whopping hematoma after the VAB, I still found it a lot easier to tolerate than the stereotactic biopsies.

In the end, my ultimate pathology was -

•Atypical Ductal Hyperplasia (ADH)
•Columnar Cell Changes
•Fibrocystic changes

I was placed into MSKCC's high risk group and told to have a gyn breast exam over the summer and to come back to them in January for new imaging. We discussed prophylactic mastectomy because I've had welllllll over a dozen biopsies in the past 15yrs. I have very fibrocystic, dense breasts and my mom had BC diagnosed in her late 40s. My surgeon said that she won't do it now, but that if I continue to require biopsies that she'll consider it in a year or two. I can't seem to get get any imaging done without a BIRAD4 and it's beyond nerve wracking. It causes months worth of terror.

Even after these past 6 months of nightmare coming to an end with what seemed like good news... My left breast (non-surgical one) has been leaking sticky, clear pinkish/orange fluid 🙄. So now I have to go back for another exam.

I hate boobs.

The surgeon did explain - and I hope that you take comfort in this- that the more imaging they do, the more they'll “find" and that it's most always incidental, benign changes. The double edged sword is that because they see it, they're obligated to chase it. So we end up terrified in the meanwhile

I wish you the best

Jen

Frenchiegal83

JeninNY geez I’m so sorry for all that you’ve gone through! Boobs are stupid, frustrating, and irritating. I work all weekend (ICU RN) so I’ll be kept busy to keep my biopsy appointment this coming Tuesday off my mind (or at least hope to)

I have a couple questions for you:

Does your findings put you in a higher risk group for a specific cancer like DCIS or just in general higher risk?

What was the reasoning for the surgeon not doing a prophylactic MX?

What is MSKCC?

I hope the next appointment to deal with your other troublemaker boob with orange stinky stuff turns out well