How to get right sample?

I have a cluster of microcalsifications in my right breast.  I first had a stereotactic biopsy.  The sample was benign but it was not the right area.  I then had an excisional biopsy.  Again the sample was benign but the pathologist could not find the microcalsifications.  I am to have a mammogram in six weeks and if the microcalsifications are still there I am advised I'll have to have another biopsy and decide which type to have. Is it possible the microcalsifications have been removed yet the pathologist can't see them?  What's going on here?  Any advice would be appreciated. Would it be safe to just watch the area for a while if they're still there?  Thank you, river view

[CCF-RN,MSN-rf]

Dear river view:  The idea of both a stereotactic biopsy and an excisional biopsy is that the location of the tissue is confirmed with mammography.  It is possible for a needle (as in a stereotactic biopsy to miss the tissue of concern).  It is also theoretically possible, although less likely, for the wire to shift in the breast tissue after placement and miss the are of concern.  If your mammogram shows a cluster of calcifications, it is probably correct to proceed with another biopsy.  Another option is to get a second opinion at a place that can also review the pathology slides.

[mammoquest]

have you researched breast mri (specifically the aurora mri)?
have you researched minimally invasive biopsy procedures such as 'vacuum assisted biopsy' & 'core needle biopsy"? discuss these procedures with your doctor as they yield less scarring & pain  with less tissue needing to be removed due to greater accuracy . greater clarity and accuracy in diagnosis stage will save you confusion later.good luck.

[surgeon]

core needle biopsy is what you had with the stereotactic procedure. The problem arises when the calcifications are in an area where it's hard to see them in all angles, making passing a needle or wire into the area more difficult. So I'd assume the problem you had has to do with something along those lines. It could be that they were removed and not seen, depending on how the tissue was processed but that's not very likely. As to safety of waiting: it depends a bit on the exact nature of the calcifications. Some are scary and some are not. MRI, as suggested above, won't likely add much info: if the calcifications are there, the only way to know for sure what they are or aren't is either to remove them, or to follow them regularly for long enough to assure they are stable....Sounds like you need to talk to your surgeon and ask what she thinks the problem was, how concerned she is about the calcifications, what's the next step and why.

[river view]

Thank you very much.  At least I have some idea of what type of questions I need to ask.  This is a wonderful site.  I have learned so much and a donation is coming to help you with this important work.

[Bet63]

Hi,
Your question touched a nerve with me. I too had cluster Microcalcifications in the right breast. A stereotactic biopsy was tried and failed in January and I had a wire location excisional biopsy 2 weeks later. Results were benign but no calcifications were seen in the sample. After healing for 2 months I had a mammo and the cluster was still there and there were more microcalcifications. Three weeks later I underwent a second wire location excisional biopsy. I was told this had never happened before(the missing of the cluster) and he (the surgeon) would get them this time. Path results were benign again but to my amazement the pathologist states no calcification is seen. I am dumbfounded. My surgeon says I can go back to my "normal" routine of yearly mammo's but I am very concerned and am considering a second opinion but having incurred over $10,000 in medical costs(thank God for insurance covering a good chunk of that) for 2 surgeries and many many mammo's I am hesitant to go through this worry and fear all over again. I have a strong history of BC in my family and this is constantly on my mind. Any advice from anyone who may have gone through this situation would be greatly appreciated.
I hope you ask your surgeon plenty of questions and get the answers you need. Look at your mammo films and make sure you get a copy of your pathology results.
I wish you much luck and hope this biopsy also turns out benign. Let us know how it turns out for you. You're right...this is a great site!!
Take care and good luck
Bet

[river view]

Thanks so much for your comments.  I am even more determined to drive the doctors nuts with questions and I plan to seek out a second opinion now.  I wonder how often this happens?

[river view]

Have seen my surgeon and have all my reports.  He agreed they are probably still there and will send me to the main hospital for my repeat mammo in a few weeks. Says my calcifications are in the middle as far as concern goes.  My birad scale is a 4 so
I will probably proceed with another steroetactic and tell them to keep trying until they get them.  Hope they'll give me a strong tranquilizer or something. I didn't find that procedure painful but it was wearing on my nerves and I think I'll be more nervous the next time.  I also plan to seek advice from my PCP as to whether I should try another hospital or second opinion elsewhere.  Bet, I hope you find peace of mind.