BIRAD 4 subclassifications

I posted this on the BC forum under Theeb4's original post before realizing this existed and thought I'd try posting it here instead therefore apologize for the repeat.
I will be having a biopsy on a cluster of microcalcifications, BIRAD 4. Not too worried (most of the time) since much of the information I've come across indicates benign findings in approx. 80% of these biopsies (pretty strongly in my favor) - my husband, on the other hand, is worried more than enough for both of us. Not that I blame him, of course, there's always that other 20%. And, to tell the truth, I love that he cares so much.
My questions:
I've been searching and searching for a breakdown of the subclassifications (4a,4b,4c) with no satisfactory success. Can anyone clarify what findings would fit into each of these categories?
I have also heard that microcals found in women younger than 50 (I am mid 30's) tend to have a higher malignancy rate - does anyone know if stats are available relating microcals to age?
Thanks for any information and, more importantly, for the support provided here.

[RavenLady]

Hi TC,
     I too am having a biopsy next week for micro calcs.  I didn't know enough when advised to thave the biopsy what a BIRAD rating was but am a quick study.  Here is what I found on the subs.  Thing is, I don't know what my BIRAD rating was except that a biopsy puts it in Cat 4 somewhere.  We will not have to go with just this rating after the biopsy and hope we both make the 80% club!  MV

From the ACR website
Category 4
Category 4 is used for the vast majority of findings prompting breast interventional procedures ranging from aspiration of complicated cysts to biopsy of pleomorphic calcifications. Many institutions have, on an individual basis, subdivided Category 4 to account for the vast range of lesions subjected to interventional procedures and corresponding broad range of risk of malignancy. This allows a more meaningful practice audit, is useful in research involving receiver-operating characteristic
(ROC) curve analysis, and is an aid for clinicians and pathologists. The optional division of Category 4 into three subdivisions internally at the facility level helps to accomplish these goals.

[RavenLady]

Category 4A
Category 4A may be used for a finding needing intervention but with a low suspicion for
malignancy. A malignant pathology report not expected and a 6-month or routine follow-up after a benign biopsy or cytology is appropriate. Examples of findings placed in this category may be a palpable, partially circumscribed solid mass with ultrasound features suggestive of a fibroadenoma, a palpable complicated cyst or probable abscess.

Category 4B
Category 4B includes lesions with an intermediate suspicion of malignancy. Findings in this category warrant close radiologic and pathologic correlation. Follow-up with a benign result, in this situation, depends on concordance. A partially circumscribed, partially indistinctly marginated mass yielding fibroadenoma or fat necrosis is acceptable, but a result of papilloma might warrant excisional biopsy.

Category 4C
Category 4C includes findings of moderate concern, but not classic (as in Category 5) for malignancy. Examples of findings placed in this category are an ill-defined, irregular solid mass or a new cluster of fine pleomorphic calcifications. A malignant result in this category is expected.

[TC66]

Hi RavenLady,
Thanks so much - this helps tremendously.  I've been researching as much as possible as well, had never heard of BIRAD before last week and the technician at the breast care center was shocked when I asked what mine was, then proceeded to explain that they further subdivide BIRAD 4.  No subclass assigned yet and don't know when the biopsy will be either. I have to go to a different center where they'll take their own mammo to determine which type of biopsy - stereotactic or surgical.

I'm right there with you sister - go well armed with as much knowledge as possible.  I thought, as I'm sure many women do, that a bioposy after a mammo meant malignancy strongly suspected - this is why so many, including myself, are needlessly terrified when that call comes.  The research I've done, this site, and the help of people like you have calmed my nerves considerably. The fear is still there, I can see by this forum that so many women can relate, but it's certainly been reduced.  

I know it'll be a little while before you know but please post your results when you get them and others who are reading this I beg to do the same.  It's comforting knowing the stats but more so when you can see those stats as a reality!!!  Besides - it's great to be able to heave a sigh of relief or our priviledge to comfort each of us as the results come in.

Here's to hopefully joining that 80% club :)

[Debstr]

In early March I had a mammo that showed two clusters if microcalcifications.  They cancelled the ultra sound order explaining that calcifications are not seen on ultra sound.   I was given a Birad 4B which was explained to me as meaning Intermediate Suspicion and when I asked what this really means they told me that from the Mammo they could not tell either way if it was benign or maliginant.  Since these were not seen on my last mammo (at 40yrs I am now 43yrs) a biopsy was recommended to validate.  The biopsy results came back fine and my surgeon told me that there was no sign of cancer.  So.. just wanted to let you know that the odds are with you.  Actually the waiting part was the worst.  I too was very lucky to have such a fantastic husband and a very close network of friends.

[RavenLady]

Hi Lori,
     I made the 90% club there so hoping I make the 80% here.  Thanks Lori!  MV

[TC66]

So glad to for you Deb and thanks for posting.  Keep your fingers crossed for us.

[cirella]

Hi RavenLady,
I know you from the OC site.  I am so sorry to hear this!  Please know that you are in my prayers.  I'll be watching to see what your results are.

Hugs,
Lori

[RavenLady]

Hey Deb,
     I appreciate you letting TC and I know your results!  That helps.  I didn't know what a BIRAD was last week but know it is probably 4B since the Doc explained three catagories, Definitely B9 (4A) Inderterminate (4B) Definately malignent (4C).  I'll have results by the end of next week when I hope to jopin you in the 80% Club!  MV

[boninclyde]

When is your biopsy? I will thinking about you and wish you well.

[RavenLady]

Hey Ladies,
     I got a short letter with results of sencond mammo but doesn't look like my clinic does subcats.  Just says ACR BIRAD 4 biopsy receommended, blah blah blah.
     My procedure is on Wednesday, when are yours?  MV

[TC66]

I have to go for a second mammo on the 26th to determine the type of biopsy. I just spoke with my obgyn's office yesterday and they found it strange that the breast care center wants to do this, esp. without having seen my original films.  Has anyone else had this experience? If so, do you know why? They also said they'd schedule the biopsy at that time, most likely for the following week.
Thanks for the well wishes boninclyde! Are you playing the waiting game at the moment too?
Best of luck to you tomorrow RavenLady. You'll be in my thoughts!

[boninclyde]

Who is sending you for the 2nd mamo? Who sent you to the first (was it your OBGYN)? I don't understand why they need a second to tell you what type of biopsy to have. Did you misunderstand them? I may have missed it from above but are you working with a breast cancer specialist? Sorry for the many questions.
I am a breast cancer survivior. I was diagnosed July 2006. Right masectomy August 25, 2006. I just try to help other ladies who may unfortunately follow in my footsteps. Without this board and another I don't know how I would have gotten through it.

[TC66]

My OBGYN sent me to a radiologist for a baseline mammo 3 weeks ago.  Upon receipt of the report she recommended a breast care/oncology specialist for a biopsy.  The specialist called, told me to bring my films on day of procedure, that I'd "likely" be having a stereotactic biopsy. They called back the following day to say they needed an in-house mammo first, then (immediately following mammo) they'd decide whether to do a surgical or stereotactic the following week. They say this is standard procedure for their center. I'll be bringing the originals for them to see, why wouldn't they base the decision on those (they haven't even seen them yet)? I'm getting the impression that this is not standard practice - any thoughts?

I'm so sorry for what you've been through and thank you for the continuing support you give here. If you don't mind my asking the following questions: What type of cancer were you diagnosed with? How was it found? And how are you dealing with it today?

[boninclyde]

They problay have seen your reports. Doctors are weird. They need to do their on so they want be sued later. They need different views which is normal. Do have the biposy.
On July 1st, 2006  I was laying in bed, Hubby was in the shower. Girlfriend  had found a huge lump 2 months earlier. So I did the a different self breast exam than normal. I picked up on my breast and rolled it around like you would roll a cigerette. I found a pea size lump. I went to my OBGYN and he said he thought it was notinhg.  He said he would schedule me for a mamo but after a few days with no appointmernt I called my PCP. I saw him and he told me it was nothing but said I was due for a mamo anyways. I went for mamo and they found widespread microcalcification even though they did not detect the lump. If not for my friends diagnosis I would not have found my cancer. Friendship goes a long way. Hers was much worse than mine. Well maybe. I wish you well. If I can help you more let me know.

[RavenLady]

I had a second mammo with the Breast center before the stereotactic was scheduled.  I am thinking this is standard process as they take magnifications helpful to the Radiologist should a stereotatic is the selected method.  Thanks and I will drop yall a post tomorrow.  MV

[abba1]

I'm posting this as someone who just had an excisional biopsy and received a benign pathology report.  The last 10 days have been miserable.  My husband and I have been so scared, but he was great.  My friends and co-workers have been really supportive, too.  I'm writing this because I hope that it will help someone else with a BIRAD 4B and waiting for the biopsy have peace of mind for a while.  I opted for an excisional biopsy with a breast surgeon instead of a ultrasound-guided one by a radiologist.  It was a good decision for me--it made me feel like I was doing something.  It is so hard to see the process for what it is:  step by step, talking to doctor, waiting for the biopsy, getting it done and then waiting for the report.  My husband really helped me get through each step, by looking at it in that way.  

[TC66]

Well, it's been a long time coming but I finally got my results.  Benign!!!!
Although report showed an area of atypical adenosis (?) - not really sure what this  means and finding close to nothing thru research so I'll likely post to the doc for clarification.  Regardless....BENIGN!!!  Congrats to you too Abba1!
Thanks to those who continue to post results.

[cacinaz]

It is 3 am.....cant sleep, reading everyone post.   I will be going to the breast clinic in a few hours for my first consultation with a doc recommended by my gyno.  bi-rad 4 b.....and concerned and scared,  but finally got some clarification from this site,  My husband lost his job between the mamogram (mammogram) and the MRI,  and have been declined for new insurance, and was not eligable for COBRA ( less the 20 employees)...I live in AZ,  make to much money for access but not enough to pay for my cost any suggestions would be appreciated.  

[lil1938]

I just recived my report barid 2   I had never heard of that before. Have a sister that had breast cancer si I was concerned. About 4 years ago I had to have  ct scan on my breast but nothing to worry about, said just make sure have them checked every year. Should I be concern?    Thanks for listing to me. I am widowed and live by myself so I guess I just need someone to talk to once in a while