Clustered pleomorphic micro calcifications

Thanks ballet12, all the waiting and speculation is gut wrenching...I've learned more on this website than I have ever from any of my doctors. And you just filled me in more. It's crazy making that they don't give you more info. I guess if they don't know until it's out, they really don't know any more than we do...ugh!

Well. I'm back.    The nurse from imaging center called early this morning and said equipment was fixed and biopsy appointment was "ON".   I'm sure a lot of people over the years here have "reported" back about their biopsy and what it was like, so I know details aren't required.  But if you're reading this, and you are just entering this breast disease/condition journey --  please hear me loud and clear:  IT DID NOT HURT.  Not even the lidocaine shot...

A few weeks ago, I had a thyroid biopsy done - I was quite scared of course.  And let me tell you - that hurt. The lidocaine shot was truly painful.  And then, when the biopsy was being done (FNA) - when the needle penetrated the suspect nodule, THAT hurt.. in a weird sort of way (hard to describe). 

So when I was on the table today and it was time for the lidocaine shot, I was preparing for the worst... and literally felt the equivalent of - let's see...  taking a pine needle off your Christmas tree, and poking the soft inside skin of your wrist... if EVEN that.  There was really no burning sensation (not like my thyroid biopsy where I thought a tiki torch had been inserted into my throat).  I felt NOTHING during the procedure. Not a thing.

When I got home - I was pretty sleepy - but that was most likely from the yummy margarita I had with my husband after the procedure.  I slept 8 hours though - and the pain was probably why I woke up. Yes, it was very achy at that point - but 2 tylenol and an ice pack - and I'm fine.

So please don't be scared.  Don't psyche yourself up - because it's all for naught.  I would do it again and not bat an eye, I promise.  Just hoping I don't have to.

Results in 24-48 hours.

I did have a bit of a shocker though -- the dr. informed me that there wasn't just one grouping of calicifications to biopsy - there were two.  No one told me this.  It wasn't on the radiology report from my mammogram, and my dr. didn't mention it. The dr. doing the biopsy today stated it was concerning and suspicious. So I had two biopsies today instead of the expected "one".  Big bummer. 

So I am preparing for the worst.  I think that's just the safest bet emotionally.  Better to be at peace with it before the big phone call, then to have my hopes up and be devastated.  I did get to look at all the digital images - before and after, as well as the images of the biopsied tissue.  This is where too much knowledge is a bad thing, because I can quite literally match up what I saw with images I've seen of cancerous microcalcifications - and non cancerous.  So my mind has really gone wild with thoughts. 

It is what it is.  It's just a breast - it's done it's duty, and it's done it well. If it has to go - well - life goes on. Right?

Pesky! I am so glad it didn't hurt, and you got one hurdle over with...It's like we have the same lifeplan in this mess or something. They didn't tell me about ANY microcals on my mammo last year and there was a cluster and now this year I have not one, but two clusters, so I will be getting both biopsied soon. What you are describing in your posts sounds exactly like what I am facing. What did you see that is making you think it's more likely malignant? Sending hugs and healing thoughts to you! Keep us posted. Ugh, I hate this waiting!

Mermaid18 -  Just saw your post (we must have posted at the same time today - because I'm only seeing it now).... When I look at radiology websites that have digital images of microcalcifications, I see ones that look like what mine looked like (similar patterns) - and it always seems to say "DCIS" after it.  But then I'll look at the next photo, that's kind of similar, and it will say fibrocystic changes.   I really think it's 50/50 to be honest.  So I'm going to choose to assume the news is the least desirable option, so that anything after that seems like good news.  LOL  Sounds crazy, I know... but being too filled with hope or confidence right now seems like a risky thing to do.   Just know that the biopsy was painless and I was very comfortable throughout.  If I could do it again - I would have taken something with to rest my ear on.. something soft (but not too high of course, because they need your head down and still).  I kept getting that suction effect from my ear being down on the surface of the table.  I ended up putting a rolled up tissue under my left eye- outter corner because it kept watering for some reason -- then I slid that under my ear later.    I promise you, though - no pain.  I felt nothing.  And even my neck wasn't too bad (probably because I'm a stomach sleeper anyway).  Please stay in touch on here and let me know how it goes for you, ok?  We're now in this together. 

PS:  I also had a bracelet on my right wrist that I wore intentionally as a distraction.  I had things clipped to it that friends gave me for good luck.  So remember - one of your hands will probably be tucked up next to your face -- so if you can hold something to look at in your hand that would be a welcome distraction, do it.    I was saying a lot of prayers, that's for sure.

Hi Mermaid...   Are you hoping they knock you out for the biopsy?    I was kind of wishing that too -- but I have a friend who sells doTerra Essential Oils -- and she sent me some samples (quickly) - which I followed her instructions on how to dab on my body in places (toes, bottom of feet, temples, etc)...  and as hocus pocus as I thought it was -- I have to say - I was as calm as a sloth.  Seriously.  Even the unexpected news of needing 2 biopsies wasn't too rattling.  It made a believer out of me!   I wouldn't even worry about needing to be knocked out for the biopsy.  I promise it was easy peasy.  Better than a dental appointment if you ask me -- I think it's the fact that it's so serious, whereas teeth aren't life or death -- that makes it a misery.  I was very pleasantly surprised at how smoothly it all went.  It's always a risk when you go under anesthesia.  I think my fear right now is that I have 2 different types of issues going on, since the 2 microcalcification spots looked entirely different.  But even then, the worst case scenario is Lefty (aka: Pesky LB) has to go.  She has served me well...  so I'll send her off into the sunset with respect (and some margaritas).  It's scary, and I'm not trying to make light of it - but in the end - it's just flesh... and we are lucky to be in this day and age where BC is detectable, treatable, and manageable caught early enough.  And thank GOD for mammograms.  I'm feeling blessed regardless of what happens.  Tick tock tick tock is right, though.. 

** I sent you a PM ...   check your messages! 

Beesie, as usual, is 100% right.  You cannot diagnose yourself based on what you see on-line.  Radiologists don't always agree, and they have seen a lot more images than you have (unless you're a breast radiologist.)

If they could diagnose you by diagnostic images, they wouldn't need to do biopsies.  But (except sometimes for the unusual inflammatory breast cancer), they can't diagnose you with breast cancer without looking at a piece of tissue under the microscope. 

Waiting is hard.  Hang in there.

pesky, the 80% benign / 20% malignant figures for BIRADs 4 biopsies for calcifications is an average.  But BIRADs 4 covers a wide range - any image judged by the radiologist to have less than a 2% risk of cancer is rated a BIRADs 3 and any image judged by the radiologist to have a 95% or greater risk is rated a BIRADs 5.  So BIRADs 4 covers everything in between.  That of course means that women who have a BIRADs 4 with less suspicious looking calcs likely have a lower risk than 20% (but higher than 2%) while other women with a BIRADs 4 who have more suspicious looking calcs have a higher risk (but less than 95%). However in the end, when you look at all BIRADs 4 biopsies for calcifications, 20% end up with a diagnosis of DCIS or invasive cancer (most with DCIS) and 80% end up with a benign finding.

I know that a lot of women read these boards but choose to not join and post themselves.  That's why it's important to me that the correct numbers be put out there.  Because there are people out there interpreting - and taking to heart - everything that we write.

To your statement, "But stats really don't mean much when nothing in life is ever predictable. Right?" I'll say, "No", for me personally that's not how I look at it at all.  For me, stats reassure me and keep me sane when I'm worried, and when things are looking bad, stats prepare me for what is likely to happen. If something shows up on my mammogram, should I equally as concerned with a BIRADs 3, where the odds are 98%+ that it's benign and <2% that it's cancer, as with a BIRADs 5, where the odds are 95%+ that it's cancer and <5% that it's benign?  Both cases are unpredictable; in either case I could end up with a benign result or a diagnosis of cancer.  But the odds that I will find myself with a diagnosis of breast cancer - i.e. those stats - are completely different in each case.  For me that makes all the difference in the world in how I deal with something, both in my head and in what I do.

If I had a BIRADs 5 image, I would realize that it is not a diagnosis of breast cancer - only the biopsy can provide that - but I would also realize that a diagnosis is highly likely. So mentally I would start to prepare myself, while still hoping for good news. Similarly, if I had a BIRADs 3 image (actually I've had lots of those), I would know that my odds of a cancer diagnosis based on whatever was seen on the image was less than 2% - and for that reason I'd be happy to agree with the radiologist's recommendation for a 6 month follow-up (rather than an immediate biopsy), and I would get through the 6 months without worrying.  Of course I understand that this 2% stat is not predictive - it's not about me but is simply an average of all BIRADs 3 - but it still is very powerful and meaningful to me. 

As for BIRADs 4, I've had lots of those too.  My first two biopsies don't count, since they were done before there was such a thing as "BIRADs".  My other 4 biopsies were all BIRADs 4; 3 were benign and one was cancer.   That's 75% benign/25% cancer, however overall on my biopsies (not counting simple aspirations), I'm at 83% benign/17% cancer.  So if I get another BIRADs 4, I'll figure that the 80% benign/20% malignant stats are pretty good for me.

pesky, I think it's important to be realistic about one's odds, and so I'm not in any way challenging your assessment of your situation.  If you think you have information that suggests that your risk is higher than average, then it very well might be. Some presentations of calcifications clearly are higher risk; I don't know if your calcs fit those descriptions or not. 

I do have to comment however on your statement "if I have bc of some sort...  the odds are up to ME".  Given what happened to your friend, I appreciate the reasons why you hold the attitude that you do, but I have to tell you that this sort of a "keep a positive attitude" message generally does not go over well here with the women who have been diagnosed with breast cancer.  The fact is that there are some days that most breast cancer patients simply feel like crap - either physically or emotionally.  Being told that you should keep a positive attitude piles on unnecessary pressure and guilt.  'You mean on top of having to deal with breast cancer, I'm not supposed to feel the way that feel?'  'So if I don't force myself to feel positive all the time I might affect my survival?'

Your friend was very lucky. Her attitude and spirit may have helped her deal with her diagnosis & treatment but was it her attitude that allowed her to survive all those years?  I don't think so at all.  If, as you say, the odds are up to the individual, how you do explain all the women who've been through this site, including those with very young children who had everything in the world to live for and who had the most positive attitudes you can imagine, and yet who succumbed to breast cancer? I've been here almost 8 years; I can think of so many very positive women who've died of breast cancer.  And in my personal life, I've known some very positive people who have also succumbed, some sooner than expected, to disease.

If you read the Stage IV forum, you will find that overall, the attitudes and posts there are a lot more positive than most of what you read here in the "Not Diagnosed" forum. So I don't for a second believe that women die of breast cancer because they are not positive about their prognosis.  Nor do I believe that they survive (or survive longer) because they have a positive attitude. 

By the way, that fact that your friend never complained to you, the fact that she always had a positive attitude in your presence, is not an indication of what she was feeling inside.  She may have been just as positive inside, or maybe not.  Lots of people with cancer present a strong, always positive image to the world, and even to their closest family. They may be trying to protect their loved ones, they may be trying to protect themselves from having to deal with the fear and saddness of their loved ones, or most likely, it's a bit of both.  That's not unusual.  But that doesn't mean that's how they always feel. You don't know what goes on in the darkest corners of someone's mind. Having gone through breast cancer and another very difficult experience in my life, I can tell you that nobody, not even those closest to me, had any idea of what my private thoughts really were.

I have nothing against having a positive attitude. It's a good thing. I think it does help you deal with whatever comes your way.  But I think a forced positive attitude, or feeling that one must project a positive attitude, only creates stress and ulcers. 

Beesie - wow.  I don't know quite what to say.  My family (immediate & many) has been touched by cancer - trust me, I know what every emotional impact is - all of it. Survival, fear, strength, and for some passing on.  But I did not come here to discuss that part of my life or feel like I need to defend my thoughts and feelings, I came here for initial support and maybe some "layman's" answers, as breast cancer is not in my family - everything else "but", unfortunately.  As for my friend, Christie - please do not assume that I do not know the pain she was really going through, or her feelings inside. I will never forget the day she called me from behind a tent at a carnival - crying - because someone's little tiny girl who was dressed up in a lady bug costume was "so beautiful, {she} couldn't stop crying" --  you see she had come to the realization that motherhood was not in her future.  Trust me - not only did I know her heart, I was painfully aware of her strength in the worst times of her life - and I admired her for that, and I intend to follow suit if I'm dealt similar cards.  I  held her hand through all of it that I could... I can't even go there with you. sorry.   To assume, Beesie, that I - in my attempt to keep my mind clear, peaceful, and positive, am somehow stomping on the feelings of others is really, truly, unhelpful and unsupportive.  This "I know cancer better than you" contest is not what I came here for.    I am leaving this forum and website now.  Thank you to the others here who have sent me wonderful messages and kind words.  I'll be praying for you.

Abigail48 - I'm glad to see that someone here understood what I was saying.  Thank you. 

PS: and for what it's worth, the doctors at MD Anderson in Houston DID believe that Christie's attitude played a huge role in her survival.  She was "the" longest living person with her cancer to date... she was very proud of that. 

Good morning!  I know that when people find they have pleomorphic microcalcifications - and begin their journey of gathering internet info - they'll stumble upon this topic as I first did....  so although I have made the choice to not get too wrapped up in discussion groups just yet..  I do feel it's important to share what I have learned about my situation with anyone who finds themselves here for the first time...

2nd "re" mammogram found Mildly Pleomorphic Microcalcifications BI RADS 4. 

Minutes before my Stereotactic Biopsy (vacuum assisted) - I was told that I had not ONE spot, but TWO spots of pleomorphic microcalcifications within a few inches of each other, and would need TWO biopsies, not one. My BI RADS status techinically went up a notch with the new finding - but it's not documented, just verbal.

**IMPORTANT** - I felt NO PAIN during the entire biopsy.  Please do not be scared.. be relaxed going in... think good thoughts (YES, frame of mind is EVERYTHING).... close your eyes.. relax your muscles from the top of your head to your toes - literally - think of each muscle, relax it. Focus on relaxing your breathing.  The pain you read about from others regarding neck/arms -- it's made worse by tensing up.  I had NO neck pain whatsoever and was not uncomfortable holding still.  I held something in my hand to keep me focused on relaxing, and the nurse helped me relax my muscles - reminding me that it will help avoid neck pain/discomfort.  Post biopsy - mild pain/swelling (ice and tylenol took care of it).. and not a single bruise - surprising.

Biopsy done on a thurs -- our specific lab has a 24-48 hour turn around (large facilities such as Johns Hopkins, MD Anderson, etc have a 24 hour turn around because they have a night shift that does the nitty gritty stuff so things keep rolling along).  My results came Wednesday morning - via our healthcare messaging system (no phone call - which I thought was odd).  And this is why...   they had a lot of examining and re-examining to do...

Results:  ADH, ALH, FEA.  All three.    Recommendation: Excisional biopsy.  It's hard to be happy about atypical hyperplasias when you have all 3.  LOL   Had it just been one - I probably would have felt more confident.

After a lot of further studying and consulting, I am having a 2nd opinion done on my pathology.  I want to share some info I've found that I've felt is particularly helpful (below). 

Pathology Process - excellent excellent webpage that explains how it all works - user friendly:

• http://pathology2.jhu.edu/pathreport_breast.cfm

ADH vs DCIS:

• http://www.pacificbreastpathology.com/blog/dr_lawtons_blog/adh-vs-dcis-2/

Importance of 2nd opinion: 

• http://www.breastpathologyconsults.com/secondopinions/secondopinions.html

Where I'm getting my 2nd opinion from:

• http://www.breastcancerconsultdr.com/second_opinion/second_opinion.html

I've begun to change my opinion on a lot of things... and feel empowered by knowledge - as LONG as it's coming from reliable sources.

Wishing you all the best possible outcome & peace.

Hi Pesky, thanks for following up.  Sorry that your results weren't completely benign and you require excisional biopsy.  I've also had ALH and ADH (can't recall if I also had the FEA).  The first time I had the ALH/ADH diagnosis (listed as "severe"), a number of years ago, I also went for a pathology second opinion.  Last year, I had the ADH on core biopsy and the DCIS on excisional biopsy (with second opinion concurring on both).  I certainly hope that doesn't happen for you.  I did have a quick turnaround for the core biopsies (although around 5 radiologists read my slides this past time--to be sure it was "only" ADH).  The excisional biopsy turnaround was longer.  Best of luck for no further findings on excisional biopsy.  Keep us posted, and glad the stereotactic core was manageable.

Hi Pesky, what you see on my "signature" is the excisional biopsy in July 2012, which was done after the most recent ADH diagnosis.  That one was an excisional biopsy because they were just clarifying the diagnosis and being sure that there wasn't anything else there.  So, they found lots of multifocal DCIS, high grade, no clean margins.  I went to a second hospital, an NCI-designated cancer treatment facility, and by the time I'd had all the tests (MRI's, etc.) and gotten several second opinions on surgeons, I had the second and third surgeries, which were lumpectomies, what they call re-excisions, to achieve clean margins.  They weren't trying to achieve clean margins in the July surgery because they didn't know, yet, that it was DCIS.  It took two additional surgeries to reach the clean margins. By the way, with "pure" ADH/ALH, they don't need to achieve clean margins, only for the DCIS.

My previous ADH/ALH diagnosis had occurred 17 years earlier, via an excisional biopsy (didn't do core biopsies then).  I subsequently had two more excisional biopsies (1999, 2008), which were both completely benign (So, I've now had 6 surgeries all on that one breast). 

You asked if I have any regrets.  Not really.  I guess what I would have done differently would have been to seek out a high risk clinic at a cancer center.  The facility that I'm being treated at now had such a clinic, and ironically, at that time it was headed up by the woman who would become my surgeon many years later.  I didn't think of myself as at extremely high risk, although I do have some family history.  So, my regret was that I wasn't put under regularly surveillance like I'm sure you will be, the six months alternating MRI/mammo's.  I did visit the breast surgeon very often in the early years, something like every three months.  I had very lumpy dense breasts.  I was always getting call backs and so for a number of years, I had mammos every six months because of that.  After I reached menopause, I thought I was home free.  I relaxed on the surveillance (although still generally got the mammos yearly).  I never had an MRI until after the most recent diagnosis, although I did discuss it with my former surgeon (who followed me for all of those 17  years).  I don't regret not taking Tamoxifen.  I am still holding off on taking hormonals due to the side effects. I actually feel that the DCIS was "protective" in some way, kind of like having protective genetics that keep the cells from become invasive.  Had I been at my current facility for the follow-up, it's quite possible that the DCIS would have been picked up sooner, so that less surgery might have been involved, but that's just speculation.

I hope that all goes well with you, and you have no surprises with the excisional biopsy.  Keep us informed.  PM me if you have any more questions or want to chat.

Sounds to me like the liver takes priority!  The breast can wait awhile.  I'd be surprised if the surgeon felt differently.

Best of luck.

Started this horrific journey in October with a regular scheduled mammo. After results came back with BIRAD 4b suspicious microcalcification clusters in right breast I was sent in to have a diagnostic mammo and ultrasound. Reading was confirmed with BIRADS 4b Likelihood of malignancy is intermediate. Was referred to a breast specialist who ordered a Stereotactic biopsy of two separate clusters. After waiting for several days report came back as : Atypical Ductal Hyperplasia, Low grade intraductal carcinoma cannot be ruled out. Microscopic calcification seen in ductal and lobular units. Sclerosing adenosis and second area was given a diagnosis of Hyalinized Fibroadenoma with associated calcifications.

I am scheduled for Lumpectomy next week where they are only going to remove the one cluster area. Should I be concerned that there is no concern of moving the second area that came back benign?

I know this is an older post, but I have been googling non stop since i found out i had the exact same thing you mentioned you were diagnosed with, I had a core biopsy last week,,awaiting the results TODAY! im a nervous wreck..cant sleep ,,im convinced the worst. I was also told i have the same microcals you have. So this gave me some hope. I just pray I get B9 results also! hope you are still doing well and ty for your post!