Stereotactic Biopsy Not Completed

So your calcs were seen on a 2D mammogram but not a 3D mammogram (tomosynthesis) when they went to do the biopsy? Or was the biopsy attempted using a different technique?

Normally a biopsy is done using whatever equipment best showed the area of concern. I agree that an MRI should be helpful to determine if a biopsy is warranted, and I also wonder why a stereotactic biopsy can't be done using the same type of mammogram machine that highlighted the area of concern.

Very odd, since 3D mammos are generally considered to be better than 2D, and the following study confirmed this to be true specifically for calcifications:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317146/

So I don't know why you were told that 3D tomosynthesis isn't as good at picking up calcifications. That's not true.

What is true is that ultrasounds don't tend to see calcifications. MRIs don't see calcifications eitherbut they are effective at seeing the cancer that the calcifications represent. The calcs themselves are not cancer but are calcium deposits. Calcium deposits usually are caused by something benign but they can be caused by cancer cells. So the MRI won't see the calcs themselves but will see the cancer - particularly if it is invasive or high grade DCIS. An MRI might however miss lower grade DCIS. The following meta-analysis suggests that MRIs can be useful when evaluating BIRADs4 calcifications:

https://pubs.rsna.org/doi/full/10.1148/radiol.2016161106

It is true that if calcifications represent breast cancer, it is likely to be Stage 0 DCIS. But "likely" isn't "always" and in some cases, invasive cancer can be found mixed in with the DCIS.

I think you should push for the MRI. Or at least have another 2D mammo to verify what the first mammo saw and reassess if the calcs are BIRADs 3 or BIRADs 4.

MollyAdelaide

Can you post the report that recommended the biopsy and the report of the unsuccessful biopsy?

Interesting article on biopsy technique used following unsuccessful stereo biopsy.

MollyAdelaide

Personally, I would have another radiologist take a look at your images as that may be easier for you than others considering your position, maybe someone you know personally. Sometimes the choice between recommending 6 mos or biopsy can be fairly arbitrary if the appearance doesn't lean strongly one way or the other. There were many times I would let the patient decide depending on their level of anxiety. Also different rads have differing skill levels in performing stereo biopsies so ask the next rad if they think they can biopsy it successfully.

I assume the reasoning for the B3 is this: If there is no mass on mammo or US, the chances of a macro IDC drops considerably. If the calcs are not the "linear branching pattern" variety then the odds of it being grade 3 DCIS drops as well. The possibilities are then benign fibrocystic type calcs vs. low grade DCIS vs. ADH or one of other atypias which are not cancer. Even if it is low grade DCIS, 6 months would probably not change the prognosis in the absence of IDC.

If you think that waiting out the next 6 months would be unbearable, ask for the biopsy, just remember that if you have an open surgical biopsy there will be a scar, and possibly for a benign condition.