Interpreting Mammograms: Calcifications
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The adjectives used in the description of the calcs are leaning toward the benign side, none of them are the types of words used for malignant calcifications so don't freak out just yet. There is a suggestion that some of them may have been there before which is good since no mass has developed since 2014 suggesting they might be benign. That being said it is still a good idea to get them sampled for the reasons previously mentioned. Even if they aren't DCIS there are things like ADH that are precursors to DCIS and breast cancer that could be represented by those calcs.
The report hints that you might be able to get an MRI due to your risk numbers. It would be a good thing to take advantage of at some point.
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what is ADH and do you mean an MRI for this? I'm scheduled for a stereotatic biopsy on the 27th. What's the difference with an MRI?
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If you are at high risk you can get a yearly screening MRI paid for by insurance. People at high risk have yearly screening mammo and screening MRI off set by 6 months from each other for surveillance.
ADH = atypical ductal hyperplasia Click here.
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Okay, good to know, thank you!
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Question djmammo, since you said even if it’s not dcis... are calcifications like this unlikely to me anything more than that? Like not invasive from how it sounds? Just because I’m being paranoid today. Thanks
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djmammo video was a great visual, thx! Is it ever appropriate to have a biopsy for numerous scattered calcifications? I guess what I’m asking, is whether or not the ones that don’t look bad can actually turn out to be cancer on biopsy? I would love to know how accurate radiology perceptions on b9 calcifications are. I’m also wondering if technology exists to biopsy scattered calcifications? Does that ever happen? I had a mammo that showed ‘numerous scattered calcifications’ and ‘magnification views of these were performed and is oblique to be adnesis sclerosis.’ They want a follow up in 6 months. I worry because of a family history, heterogeneous density, and troublesome nipple changes. I am thinking of getting a second opinion. Am i just worrying? Or could scattered be cancer
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I actually just had a biopsy today on scattered calcifications but I also have a family history as my mom had stage 1 last year. They were going to biopsy 2 areas but then after looking st one area, decided it was probably benign because they’re very layered. The other area is scattered which they said is less concerning but they still did the biopsy. I’m feeling more confident about all of this but your questions have me thinking. They actually wanted game to go for an mri first because I have dense breast tissu
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this is a good article about it, https://breast-cancer.ca/micro-overviews/
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Hi --
I hadn't had a mammogram for about 8 years and got one this fall (I'm 51 and a friend was recently diagnosed with stage 4 breast cancer). Later, my PCP said the mammogram was abnormal and I needed to go in for a diagnostic mammogram, which I did this past December. The sweet tech-person consulted with the radiologist, and then came out with the radiologist who said that I should get a biopsy (and then promptly left), which I was fine with - until the tech said "I'm so sorry" and went in for a hug. She was very sweet, but her comment made me worry that this was perhaps a wee bit more serious than I was thinking it might be. My mammogram was listed as abnormal, suspicious Birads 4.
The report also noted:
- 2 separate areas of fairly coarse grouped calcifications
- Mild pleomorphism
I went in for a stereotactic biopsy but the placement of the two clusters that the radiologist is concerned about were unreachable. So, because they were already in there with the needle, they took out some other calcifications. Afterward, the radiologist said that some of the calcifications were faint and amorphous and the next steps would be waiting 6 months for another mammogram or getting the two clusters of calcifications she is concerned about surgically excised.
When I spoke to my PCP later in the day, she said that she spoke to the radiologist and if it were her, she'd just go ahead and do the surgery now instead of waiting 4-6 months. So, my surgery is this Monday. I'm not panicked because I figure that it is *so* early in the game that even if the calcifications turn out to be malignant, it would still be highly curable.
So, my questions are:
1. How quickly do calcifications turn into cancer? I know that not all calcifications turn into cancer - but if they were pre-cursors to it, would waiting 6 months increase the risk of not being able to fight it? I am slightly concerned that my PCP was pretty clear that I should get them excised and not wait.
2. After I made a surgical appointment, I called the breast center where I had the stereotactic biopsy and the person who answered the phone let me know (I didn't ask) when looking at my biopsy report that the calcifications that they got from me (the ones that the radiologist was not particularly concerned about), were benign hyperplasia. I'm curious as to whether or not this will be a good sign about my other, "suspicious" calcifications and second-guessing whether or not I should have them excised for biopsy or should I have just waited 4-6 months for a biopsy. Thoughts?
3. My mammogram was listed as Birads 4, but not A, B, or C. I called the radiologist and they said they don't rate Birads 4 with different levels. However, because there was some "mild pleomorphism," would it be fair for me to guess a Birads 4b and 30% chance of malignancy?
My current frame of mind is calm, curious, and science-focused. I figure I can't worry about something I can't control, and the likelihood that I'll be just fine in the end is high. But still, I can't help to but to have questions and want to fill my head up with as much knowledge as I can...
Thanks for any thoughts ...
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1. How quickly do calcifications turn into cancer? I know that not all calcifications turn into cancer - but if they were pre-cursors to it, would waiting 6 months increase the risk of not being able to fight it? I am slightly concerned that my PCP was pretty clear that I should get them excised and not wait.
Calcs do not turn into cancer. Some cancers make calcifications early on in their development and these are often the first sign of the presence of a cancer before a mass forms. There are many benign conditions that form calcs and in the early stages all calcs can look alike.
2 "...biopsy report that the calcifications that they got from me (the ones that the radiologist was not particularly concerned about), were benign hyperplasia. I'm curious as to whether or not this will be a good sign about my other, "suspicious" calcifications and second-guessing whether or not I should have them excised for biopsy or should I have just waited 4-6 months for a biopsy. Thoughts?
They would have to be COMPLETELY 100% IDENTICAL to just watch the other set of calcs.
3. My mammogram was listed as Birads 4, but not A, B, or C. I called the radiologist and they said they don't rate Birads 4 with different levels. However, because there was some "mild pleomorphism," would it be fair for me to guess a Birads 4b and 30% chance of malignancy?
As I have mentioned in many other posts those letters do not apply to you. They are used to judge the performance of the radiologist i.e. "how sure were you this was a cancer when you recommended the biopsy?". This is correlated with the biopsy results and the radiologist's yearly false positives and false negatives are calculated. As a corollary, each time we biopsy something we think is benign but the patient wants it done, it counts against us in our yearly evaluation. The "% chance of malignancy" is clinically meaningless if you are going to have a biopsy. It only really matters if you are watching and waiting.
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I originally posted this in a different spot but was suggested to post this here. I hope this is the right place
Hello all. I am 44 and I had my first ever screening mammogram in early June. The next day my report was posted in my online patient portal. After reviewing the findings with Dr. Google I'm not sure what to think.
My dr never called my to discuss anything. About two weeks later the breast center called to schedule my follow up mammogram. The earliest appointment she could get me is for early August. Two months after my screening!
Does that mean that they don't think it's a big deal so they don't feel the need to get me in quicker? Should I be less worried since my dr never called me to tell me anything? I know you guys probably don't have the answers I'm looking for but I feel like you all might relate. My husband is a big worrier so I can't really discuss any of my concerns with him. I just told him it's common to be called back since it was my first mammogram (which I believe is true).
Anyway, I posted the dr findings below. I'm not sure if I'm allowed to do that so please let me know if not
Breast tissue is extremely dense possibly obscuring small masses.
In the right breast, there is segmental distribution of partially obscured
punctate and pleomorphic microcalcifications near the 2:00 axis mid to far
depth, requiring additional evaluation. No additional suspicious mass,
calcification or architectural distortion is seen. No acute skin or nipple
abnormalities.
In the left breast there is no suspicious mass, calcification or architectural
distortion is seen. No suspicious skin or nipple abnormalities.0 -
Unilateral calcifications are always called back for magnification views. Also, without prior studies we don't know how long they have been there.
After the magnification views they may do an ultrasound. If the calcifications are not clearly benign looking on the followup studies they will likely recommend a biopsy.
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Hello, this is the first time I have ever posted on a forum, so forgive me if I am posting in the wrong place. I had a 3D mammogram on 9/6 and was called to come back in a few days later to get additional imagery and an ultrasound. The point of contention was calcification. My mammogram from a year ago was categorized Birads 2 and calcifications benign. After the follow up on this year's mammogram, they redefined it as Birads 3 and a six month follow up - yet all the radiologist said to me was "your calcs look fine" If that is the case, I am wondering why they didn't just keep it at Birads 2 - same as the 2018 screening. No description of the calcifications on the 2018 report, and on this report all it said was round, loosely grouped calcifications. Heterogenously dense.
Apologies again if I have posted in the wrong place. I am just frustrated as to why they changed from birads 2 to 3 if everything looks fine.
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I picked up copies of my medical records today hoping what I would receive would have more details than what was released to me through my patient portal, but it is just the same. At the time of my diagnostic mammogram with ultrasound, the radiologist gave me two options - have a biopsy or wait 6 months and do a follow-up diagnostic mammogram. My impression was waiting was OK. My family is pressuring me to schedule the biopsy because that option was left on the table in the radiologist's notes. Their point is why would I be given the option if it is not clinically necessary.
My screening mammogram (3D) and ABUS (as I have "extremely" dense breasts) found a "new calcification with grouped distribution." Nothing about size or shape of the calcifications. The diagnostic mammogram (3D) with magnification and ultrasound finding is "subtle calcifications with grouped distribution" Neither ultrasound showed anything. I was labeled a 3 - Probably Benign Finding.
Are there any additional questions I should be asking? Does a biopsy with the probably benign classification something I need to verify with my insurance will be covered? Does the classification usually need to be higher to warrant the biopsy? Any advice on where to turn to for "better" information so I can make a final decision about which side of the fence I should be on?
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Personally when I assign a B3 to a study I always gave the patient a choice of either waiting or having a biopsy and the answer varies from "can you biopsy it today?" to "I really hate needles I'll wait the 6 months" and everything in between. Many times when I tell a patient to come back in 6 months their facial expression changes drastically prompting me to say "...or we can biopsy that for you next week". If they do desire the biopsy I dictate it as a B4 for insurance purposes, as since the decision was made before they left the facility I dont need to make a change in a report.
I have to think that they would not have called it a B3 if they thought it needed an immediate biopsy.
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Good morning - I am hoping you can provide some insight into the report that was sent from radiology to my PC. Pathology hasn't provided a report yet and I'm starting to freak out as I don't think the results will be good news.
PROCEDURE 1: Stereotactic core needle biopsy of the right breast:
IMPRESSION:
1. Status post right breast stereotactic core needle biopsy of the 0.8 cm
grouped coarse heterogeneous calcifications in the lower inner quadrant.
Adequate placement of the M-shaped tissue marker.
2. Status post left breast stereotactic core needle biopsy of the 0.4 cm grouped
amorphous calcifications in the upper outer quadrant. Adequate placement of the
coil shaped tissue marker.0 -
In the scheme of things these are very small groups of calcifications and this is the value of a minimally invasive computer directed biopsy device.
If all your other imaging has excluded the presence of a mass, the results of these biopsies usually range from benign calcs associated with fibrocystic changes to ADH and other atypias, to DCIS. The odds of an outright invasive cancer are lower when there is no demonstrable mass.
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Thank you so very much for your quick response. I am able to breath and try to wait patiently. Enjoy your Sunday!
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The pathology report from biopsy on Thursday - BC both breasts is what I think my primary said...no idea what the next steps will be
Final Pathologic Diagnosis
A. Stereotactic Core Biopsy Right Breast with Calcifications:
- Breast parenchyma associated with coarse microcalcifications in the benign sclerosed ducts.- Background breast parenchyma shows flat epithelial atypia, atypical lobular hyperplasia and
stromal fibrosis.
B. Stereotactic Core Biopsy Right Breast no Calcifications:
- Benign breast parenchyma with proliferative fibrocystic changes composed of usual ductal
hyperplasia, dilated ducts and stromal fibrosis.
- Negative for atypia and malignancy.
C, D. Stereotactic Core Biopsy Left Breast with and without Calcifications:
- Ductal carcinoma in situ, focal microinvasion cannot be completely excluded.
- Immunostains for calponin and p63 are pending and will be reported in an addendum.
- See surgical pathology cancer case summary
Surgical Pathology Cancer Case Summary
Procedure: Stereotactic core biopsy
Specimen Laterality: Left
Tumor Site: Upper outer quadrant
Size of DCIS: 4 mm
Histologic Type: Ductal carcinoma in situ
Architectural Patterns: Cribriform
Nuclear Grade: Intermediate
Necrosis: Focal
Microcalcifications: Present
Additional Pathologic Findings: None
Ancillary Studies:
Immunohistochemistry performed at Lowell General Hospital and evaluated using digital image
capture and analysis by the FDA-cleared GenASis Scan system shows the following results:
Estrogen Receptor (Clone SP1): Positive; 96 % positive, 2.9 intensity (scale 0-3)
Progesterone Receptor (Clone IE2): Positive; 48 % positive, 2.0 intensity (scale 0-3)
Appropriate positive and negative control tissues (including internal controls for ER and PR)
were reviewed for all of the reagents and shows appropriate staining.0 -
Hi. I'm new here so I hope I'm posting in the right place. I'm 42 and I had my first mammogram on Tuesday. I got the results the next day.
Here is what it says:
INDICATION: Annual screening mammography. Family history of breast cancer in the patient's grandmother.
COMPARISON: None. Baseline study.
BREAST COMPOSITION: c. The breasts are heterogeneously dense, which may obscure small masses.
FINDINGS: Tomosynthesis imaging was obtained and reviewed as part of this examination. There is no suspicious mass, area of architectural distortion, or group of calcifications in the left breast to suggest malignancy. Calcifications are seen in the upper outer quadrant of the right breast middle third.
IMPRESSION
Abnormal findings in the right breast.
RECOMMENDATIONS:
Diagnostic right mammogram, to include spot compression magnification views, ML view, and ultrasound as needed.
- I'm scheduled for diagnostic mammogram and ultrasound on March 22nd. I'm really freaking out. Could this be possible cancer? Do you think I'll need a biopsy? The report didn't say anything about shape, size etc.
Thanks!
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MissMack,
This thread has been inactive for well over a year and djmammo has not signed on for several months. Have you spoken to your doctor about the meaning of your results? I tend not to interpret the test results of others because I have no medical qualifications, however, it does say you have calcifications (not cancer) in your right breast. A diagnostic mammogram will look more closely at this but, again, likely not cancer. Don’t freak out and please call your doctor for the correct interpretation of your situation. Take care.
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hi, sorry I didn't realize about this thread being inactive. Yes, I've spoken to doctor. They are concerned, going for the diagnostic mammogram etc March 22nd.
It states no cancer in left, but doesn't say that for the right where the calculations are.
I guess I'm just trying to find out the likelihood of calcifications being cancerous.
Sorry.
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Hi MissMack27,
With no description of the calcifications themselves, the pattern of their distribution and no measured size of the area of distribution of the calcs it is impossible to hazard a guess.
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MissMack,
Calcifications themselves are not cancer. I am not sure that anyone here, we are not doctors, can give you the likelihood of anything. While there are no guarantees, the chances are very much in your favor. I know waiting is torture but try not to dwell on things you don’t yet know about. Take care.
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MissMack, I replied to your other post here:
Topic: Calcifications on mammogram
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