BIRADS 4B Scared

"linearly distributed pleomorphic calcifications"

BIRADs 4B has a 10% - 50% chance of malignancy. If your biopsy is not benign, from the description, the most likely diagnosis will be DCIS, which is non-invasive and Stage 0. When calcifications are not benign, usually (I think something like 80% of the time), the diagnosis is DCIS. DCIS cells are confined to the milk ducts, and as the cells multiply, they spread out within the duct, forming a linear pattern. Invasive breast cancer (IDC), on the other hand, is in the open breast tissue and generally forms a solid mass as the cells multiply.

Most IDC starts out as DCIS, and DCIS and IDC are often found together, so whenever DCIS is found, it's possible to also find some IDC. But with no visible mass or architectural distortion (which is often how IDC presents on imaging), if there is any IDC present, it is likely a very small amount.

As for nodal involvement, with any amount of invasive cancer, it's always possible to have nodal involvement. But with a small early stage invasive cancer, the likelihood is low. I don't know the percent, but I would expect that it's probably no more than 10%.

If you go through the math - 50% chance of malignancy (worst case); if malignant, 80% chance of DCIS and 20% chance of IDC; if IDC, 10% chance of nodal involvement - you come up with 1%. But that's dangerous math, because it's piling one probability on top of another probability on top of another probability. So I wouldn't say that your risk of nodal involvement is only 1%, but it's probably fair to say that based the description of your suspicious calcifications, the risk is probably very low.

As for the cancer being there for some time, that's true of most cancers. Breast cancer as a rule is slow growing, so it is often in the breast for 3-5 years, or sometimes as long as 10 years, before it becomes large enough to be noticeable on imaging. With DCIS, because it is non-invasive, or with an invasive cancer that is not aggressive, the time doesn't matter. But with an aggressive cancer, even if it's found very early and while it's very small, there is a greater risk that it might have already started to spread. The aggressiveness of a cancer is determined through a genomic analysis of the cancer cell, and treatment is based on the aggressiveness and type of cancer. Hopefully none of that is anything you will need to worry about.

Some excellent information on calcifications: https://radiologyassistant.nl/breast/calcifications/differential-of-breast-calcifications

Good luck with the biopsy!

Edited to Add: everythingwillbefine, did you post this same information in djmammo's "Interpreting Your Report" thread? I just looked there, and your post was "Removed by the Community". If you posted exactly the same info there as here, you might want to contact the Moderators to find out what happened. If the post was removed in error and it contained no rule violations, the Mods should be able to reinstate your post.

You're welcome!

It's easy to over-think things when you are anxiously waiting for a biopsy, biopsy results, or surgery results. Our minds tend to go to the worst case scenarios, even if the symptoms aren't pointing there. In most cases the outcome is not nearly so dire as we worry about.

I see that your post in djmammo's thread has been reinstated. He's the expert so it will be good to get his opinion on your imaging report.

Praying for you. Wishing you the best.