Not sure where to go with all of this . . . .

It's time for a second opinion.  It's a small area.  The delay is probably not consequential.  At the very least, you need a second opinion on the mammo films (not really films any more).  It sounds like you were in the borderland between a BIRADS3 and a BIRADS4, so it's strange that the radiologist wrote BIRADS4, but then recommended wait and see.  As to why they originally recommended an excisional biopsy vs. a stereotactic biopsy, the only thing I can think of is that the area is very small or where it's located, it could be difficult to get at the calcs, but that apparently wasn't mentioned in the original mammo report.  The third thing that is unclear is why they didn't get at the calcs, and why you didn't know that right away.  Here's why.  When they do a stereotactic biopsy, depending on the location of the calcs and the size of your breast, when they compress, it may be difficult to get at the calcs from any angle.  Usually, they tell you that before they do the stereotactic biopsy, saying something like: "This might not work."  At the time of the stereotactic biopsy, they are supposed to XRAY the samples to determine if the calcs were present in their biopsy samples.  You should know that information while you are still on the table/in the biopsy room.  You should know if they succeeded or not, because they do need a plan if the stereotactic biopsy doesn't work. 

I have had this situation several times, where they said that they might not succeed at getting to the calcs. In the end, they have always succeeded.  I did have one other situation where a surgeon advised excisional biopsy, because he thought that the stereotactic biopsy would be impossible, and that time I did go straight to the excisional biopsy.  It is generally better to try a stereotactic biopsy first, because excisional biopsies are more invasive and do leave long term scarring, which can affect future imaging.  Now, as to the borderland BIRADS3/BIRADS4 issue, I had the reverse situation to you.  I had a mammo on the contralateral breast (the one without the DCIS), my first since the DCIS diagnosis.  The radiologist found a cluster of calcs and I was given a piece of paper which said come back in 6 months to follow an area of concern.  There was no BIRADS listed, because it wasn't the final report.  I went from the mammo area to see my surgeon for follow-up with her.  When she heard that I got the 6 month follow-up report, she called the radiologist, who said that she was "on the fence" about whether to biopsy or not.  The surgeon said to her and to me, "why wait?  what if it's DCIS again?" so I had the stereotactic biopsy, but in order to have it, the radiology report was written up as a BIRADS4 although it basically said it was being done to confirm benign results (and they were, in fact, benign).  So, there is definitely a gray area.  Now, like you, I'm going back for a 6 month follow-up. 

About whether your calcs are the "original" calcs or different calcs, if they didn't find calcs in the specimen, it seems that they missed them the first time around.  Again, that's not malpractice in itself.  It happens, due to technical complications in trying to get at the area.  What is strange is that they didn't seem to check to see if they got the calcs OR they didn't tell you that.  Now, if they don't get the calcs and they are really worried about the area, they should absolutely go immediately to excisional biopsy.  In my case, in this last scenario, I told the surgeon that if they didn't get the calcs, I wanted to speak with her before going to excsional biopsy, and she fully agreed.  She said the team would discuss options (surgery or wait, etc.)

Bottom line, get a second opinion.  Don't worry about the passage of time.  Get this straightened out so you can make a decision you are comfortable with.

Best of luck.

Hi Old Oak Tree,  your situation is very complicated.  Is it possible to get a radiologist second opinion (having the "films" re-read, not necessarily involving you personally).  You have so many issues, it's understandable you are concerned and maybe confused. 

About the calcs, they probably should have told you before they completed the procedure, UNLESS, they thought it would be impossible to go in from a different angle, i.e. they'd done all they could.  My marker migrated considerably after the stereo during the biopsy last June (it's still in me).  They had to do the excisional biopsy based on where they saw the cluster of calcs on pre-surgical mammo.  They told me they had the parameters of where those calcs were located based on the original mammo.  At the site of the original calcs found by stereotactic biopsy, ADH had been found.  When they went back in for more calcs in the excisional biopsy/lumpectomy, they found the DCIS (lots of it--over 5 cm) and calcs were in some of those samples.  Then, since I had multifocal DCIS and no clean margins, I finally went to the "big guns" (Memorial Sloan Kettering).  There I discovered that the surgeon for the first surgery had not "marked" the margins for location (superior, inferior, etc.)  So, the second surgeon had to go in by "feel" or "look" to find where the previous surgical margins were, and then to expand upon them.  Since it wasn't an easy situation, there was still one remaining margin that was not clean (previously--the DCIS was at all margins) after that surgery was done.  With a third surgery, she was able to succeed, but with this kind of story, now you know why radiation is a must.  Who knows what was there and what still remained.  This is not an exact science.

Hi Old Oak Tree, I got a second radiological opinion once with a radiologist who had retired from the practice at the teaching hospital I went to.  One of the techs at the hospital got me his information.  This radiologist basically did this kind of consultation, post retirement.  I know that Dr. Michael Lagios (the one that everyone writes about) does second radiologic opinions.  He's in San Francisco, I believe, but people seek him out from all over the world.  You could also contact the Johns Hopkins Breast Center.  I think they might be able to do it, or any NCI-designated facility in your state or your immediate area.  Best of Luck.

"all is benign"-----what wonderful news! so happy to hear it, now celebrate and relax!

anne

OldOakTree, I couldn't be happier for you. That is great news!

As to the 2nd opinon, it really just depends on how you feel after this Dx.

I wish you all the very best with whatever you decide.