In anticipation of biopsy...

My routine mammogram showed microcalcifications.  The follow-up diagnostic films confirmed a "new group of 15-20 (micro) calcifications" in the same localized area (cluster?).  I have no palpable masses, no family history or other major risk factor other than age (49).  The surgeon plans to try a needle biopsy (in 2 weeks!) but may have difficulty due to (small) breast size.  If that is the case he will have to try lumpectomy.  Needless to say I am very anxious and this will be a long, 2-week waiting period.  The surgeon explained that due to the large number of microcalcifications, the likelihood of a malignancy jumps from 20% to 30%.  I live alone and I am too emotional right now to discuss this with friends or family members.  Please give me any feedback or information that might help me to understand what I am facing.

[CCF-RN,MSN-JS]

Dear Mebs, Microcalcifications do not necessarily mean that this is cancerous.  The concern is that they are clustered and the question as to why they are clustered together leads to the further evaluation - thus the biopsy.  

Likely the type of needle biopsy they are referring to is a stereotactic biopsy.  In stereotactic biopsy, computer-assisted X-rays allow the biopsy needle to be precisely positioned, especially for smaller lumps or lumps that cannot be felt.  Special mammogram films are taken of the site to be biopsied.  The radiologist uses these films and, with the assistance of a computer, calculates the exact location for needle placement to obtain the biopsy.

The procedure begins with cleansing the skin and applying a local anesthetic to numb the skin surface.  The radiologist then introduces a sterile biopsy needle.  Additional X-ray films are taken to confirm accurate needle placement.  Tissue samples are obtained through the needle.  It is standard procedure for the needles to be inserted three to five times in order to obtain an adequate tissue sample, this portion of the procedure takes ten minutes or less.  The biopsy site is so small, a Band-Aid is usually all that is applied, and a woman can resume her normal activities after the procedure is completed.  The entire procedure takes about one hour.

[surgeon]

calcifications are pretty common in the breast; by far the most typical causes are non-cancerous. It's less about number than the nature of the actual calcifications themselves. By needle biopsy, I assume you mean "stereotactic biopsy" wherein a needle is passed into the area using xray guidance. It's quite accurate, and most often minimally uncomfortable. The odds are on your side that it'll be benign. And even if it turns out to be cancer, by finding it this way, before it's palpable, the chance of cure is phenomenally good.

[mebs]

What are the non-malignant causes of a cluster of microcalcifications?  Everything that I have read (on the Internet) seems to point to gloom and doom for this presentation of the microcalcifications.  And if this were to be malignant, what would the treatment entail and what are the survival statistics?

[mebs]

One more question...  In my case, the microcalcifications are located "at 9 o'clock" and occupy an area of about 1 cm diameter.  At this point, imagining a malignancy, what is the probability that there could be involvement of lymph nodes or a spread to other areas?

[surgeon]

calcifications occur within cysts; within blood vessels; within ghe milk glands. They are a common response to various kinds of irritation or inflammation of the breast tissue. Many mammograms show them. Of those that are considered of concern, around 90% turn out to be due to benign causes. As to the chances of spread if malignant, it's really impossible to say before the tissues are examined. Many malignancies discovered by the presense of calcifications turn out to be in the very earliest stage (carcinoma-in-situ)with virtually 100% chance of cure and 0% chance of spread.

[Bet63]

I understand what you're going through. I too had cluster microcalcifations and was sure it was cancer after researching on the net.I'm 39 with a strong family history of breast cancer. My surgeon ordered a stereotactic biopsy which did not work because of my small breasts and the location of the microcalcifications(upper portion of breast). They tried for 45 minutes to get them to show up on the digital mammo. I ended up having a rather large lumpectomy which turned out to cysts and fibrocystic tissue which is thankfully benign. Did they say anything about needle localization before your lumpectomy? I had that because I also had no palpable mass, just these cluster of white specs on my mammo.
I know you're scared but try to think positive. Chances are good that there is no cancer there. I had myself scared to death thinking about what Could Be. Don't do that to yourself.
Please don't hesitate to ask any questions. I would gladly help you if I can.
Take care and good luck to you.

Bet

[mebs]

Thank you for relating your personal experience.  Yes, the surgeon did say that if he is unable to get enough tissue during the needle biopsy, he will use needle localization to perform a lumpectomy.  But he also mentioned lumpectomy and mastectomy in the same breath.  This all happened so fast and I was so numb that I did not even know what questions to ask.  And yes, you are right in assuming that I am terrified.  (Not of the procedure but of the results...)  Your comment and that of "surgeon" did help to settle me a little, but it is still a long and lonely wait without knowing where I am headed.

[mebs]

To those of you who have have experience with this, maybe you can clarify this a bit more.  What is the number of calcifications that showed on your diagnostic mammogram and what was the final diagnosis?  What is the relationship between the number of clustered microcalcifications and the diagnosis?  Thank you.

[Bet63]

I dont know how many calcifications were in my cluster, they were tightly clustered though. Mine were located at about the 12 o'clock position. I think the way they are clustered can sometimes be a clue as to what they are caused by.
My surgeon also talked of lumpectomy and partial mastectomy in the same breath. Those words are probably some of the scariest a woman can hear.
But as "surgeon" says there are alot of benign reasons for microcalcifications. I found that mine were probably due to apocrine metaplasia (that was on my pathology report from my lumpectomy and I researched almost every word that was on there) and I also had lots of cysts that I had no knowlege of prior to biopsy.
Have they said anything to you about dense breasts? That may also be a factor.
Anyway, I hope you can try to not worry quite so much although waiting for the biopsy and then the results is somewhat like torture. Its amazing how your mind can go wild. I know mine did.
My thoughts and prayers are with you and again...if you need someone to listen, I am here.

Take care.

Bet