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Biopsy tomorrow for calcifications BI-RADS 4B

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eviec1
eviec1 Member Posts: 80
edited May 2021 in Waiting for Test Results

Hi all, Just wanted to get some thought and reassurance from those who have been in this situation. I had my first mammogram screening two weeks ago which came back with suspicious calcifications. I had the diagnostic mamm last week which confirmed the suspicions and I am scheduled for a biopsy tomorrow. I am going out of my mind with worry. When I spoke to the radiologist following the second mamm, he said he was pretty sure it was DCIS and would need a lumpectomy. This was the report:

Finding in the right breast is suspicious. Biopsy should be considered. There
are loosely grouped coarse heterogeneous and punctate microcalcifications in the
upper outer quadrant of the right breast at 10:30, 8 cm from the nipple in a
segmental somewhat linear distribution.

Suspicious Abnormality (Intermediate Suspicion For Malignancy) (ACR BI-RADS 4B)

From what I have read online, segmental and linear distributions has a high correlation with malignancy. But is it ever benign? Does anyone with this kind of calcification ever get a benign result? Also, while the radiologist said DCIS, is it also possible that this could be invasive? He said it was unlikely, but I have read so many stories of what was thought to be DCIS turning out to be invasive and sometimes quite advanced.

Anyone have any experience with this? I am new to it all and feeling pretty overwhelmed. Thank you for any insights you can share.


Comments

  • Janet_111
    Janet_111 Member Posts: 9
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    I am sorry you are going through that . I have biopsy in few days they said Birads 4.

    I am same like you and don’t have lot of information.

    I hope your turns out to benign.

    There is many nice people with lots of information . Hopefully someone response your question.

    Beesie is very helpful to everyone and I am sure she will help you out with your question.


  • salamandra
    salamandra Member Posts: 745
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    Yes, it could be benign. In fact, according to a 4B, there is almost a better than not chance that it's benign.

    Yes, there could be invasive cancer hanging out in DCIS that may not get discovered until after final surgery.

    You're in a scary and uncertain time because all the possibilities are open. You are going for the biopsy because even the best radiologist in the world wouldn't give you a firm diagnosis without it. The biopsy will be the beginning (and if you are lucky, end) of the answers to these questions.

    If the doc is right and it is DCIS, you will still be waiting on a lot more answers. Waiting can be the hardest thing of all for some of us. You have to find what works best for you to get through this time. Heart

  • eviec1
    eviec1 Member Posts: 80
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    Yes, the waiting does indeed seem the hardest part. My mind is constantly moving in a hundred different directions and I don't know how to focus it and calm it down. And then even after the biopsy tomorrow, there will likely be more waiting for the results. And I feel so completely helpless. If I at least had a clearer idea of what the range of possibilities were, I could focus myself on that and plan. But there seems to be no doing that right now.

    And good luck on your biopsy, Janet_111. I hope you get good results!

  • beesie.is.out-of-office
    beesie.is.out-of-office Member Posts: 1,435
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    Yes, your calcs could be benign. "Coarse heterogenous" is suspicious but not highly suspicious (as fine pleomorphic would be). "Punctate" tend to be benign. "Linear" and "segmental" often describes the appearance of DCIS (where the malignant cells line a narrow milk duct) but your description includes the word "somewhat" so it may be that the calcs are scattered in a way that could be interrupted as being segmental and linear, but may just be random. The BI-RADS 4B assessment means that your radiologist believes the risk of malignancy to be between 10% and 50%. This means that the odds of a benign finding fall in the range of 50% to 90%.

    Could this be invasive cancer? Yes, it's possible that there could be a very small area where malignant cells have broken through the duct wall and have evolved from being DCIS to becoming invasive cancer. But to your comment, "I have read so many stories of what was thought to be DCIS turning out to be invasive and sometimes quite advanced", I'd say that with the description of your imaging, the odds that you will be found to have an advanced invasive breast cancer are very small. I don't know where you've done your reading, but I've been hanging around here a long time and I've read lots of studies about imaging, and I have not seen many cases that were thought to be DCIS turn out to be an advanced invasive cancer. Anything can happen, but the likelihood of a benign result is many times greater than your likelihood of being diagnosed with an advanced breast cancer.


    image

    Differential of Breast Calcifications https://radiologyassistant.nl/breast/calcification...


  • eviec1
    eviec1 Member Posts: 80
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    Thank you so much for your informative response, Beesie. That is very reassuring! The worst for me is being caught off guard - like, if I go in thinking, "OK this may be something, but if it is, it's early and treatable" and then being thrown for a loop with a totally different diagnosis and prognosis. If it could be advanced, I'd rather know that now and mentally prepare for it than have a false sense of security only to get a shock later. But it sounds like the likelihood of that is low, which is very good to know. In terms of where I've been reading.....Well, Dr. Google. Some legitimate studies (which is how I found the high rate of malignancy for segmental and linear distributions - that's pretty concerning), and some just random stories which I suppose can't be verified for accuracy. So glad I came across this site today :)

  • LivinLife
    LivinLife Member Posts: 301
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    Welcome eviec! If this helps I actually had the opposite concern you describe. I started out with a 3 cm area of DCIS by diagnostic mammo + an additional 3 cm area of "stuff" found on MRI. They expected to find invasion with such a large area. About half the DCIS was removed in biopsy and was DCIS only. Pathology after surgery showed the other half of DCIS plus lots of benign and precancerous conditions though no invasive cancer.

  • eviec1
    eviec1 Member Posts: 80
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    Glad to hear of your (relatively) good result. Today's the day for the biopsy and at this point I'm trying hold it together. One step closer to an answer, I suppose.

  • Janet_111
    Janet_111 Member Posts: 9
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    Thanks you so much eviec 1