Dr. Esserman suggests that low-risk calcifications not be biopsied. Here is what she said in an email correspondence: “With a history of DCIS, if you have new calcifications, it will be hard to assign these a low probability of malignancy. For the masses, you should ask the radiologists if they fit in the BIRADS 4A category (less than 10% risk of malignancy). If they think this is likely a fibroadenoma, you could pass. However, if the masses are in an area of prior DCIS, again, the radiologists are not likely to give a new mass a low likelihood of malignancy. The key is whether these are new for sure. If they have been present and are stable, then you can probably do close follow up (check in 6 months). So, getting a more precise risk estimate from the radiologists, and finding out whether they are new from prior exams is the key. Also, it is important to make sure that the calcifications are not just showing up because your screens have switched from film screen to digital exams.”
Following are the different types of biopsies which serve to remove breast tissue samples for testing:
- Core needle biopsy. A radiologist or surgeon uses a hollow needle to remove tissue samples from the suspicious area. The tissue samples are sent to a lab for analysis.
- Stereotactic biopsy. This type of biopsy also involves removing tissue samples with a hollow needle, but with the help of stereo images — mammogram images of the same area obtained from different angles — to find (localize) the area of concern.
- Surgical biopsy (wide local excision or lumpectomy). If results from a core needle biopsy or stereotactic biopsy show areas of DCIS, you’ll likely be referred to a surgeon to discuss your options for surgically removing a wider area of breast tissue for analysis.
A pathologist will analyze the breast tissue from your biopsy to determine whether abnormal cells are present and how aggressive those abnormal cells appear. If your mammogram showed microcalcifications, the pathologist will examine the biopsy sample for those abnormalities.
Sam Knight said:
I guess my question to Dr. Esserman is – what’s the definition of a low risk calcification and how can you know this without a biopsy? I’m confused on when you need a biopsy.
Good Question, Sam Knight. I have the same question myself.