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Suspicious Abnormality on Mammogram
I'm 47 years old needing a breast biopsy. I had a routine mammogram that showed a spot (no lump is felt)and then I had a spot compression with magnification . The findings were:
Presence of cluster of microcalcifications in the left outer quadrant. They are somewhat pleomorphic. Possibility of intraductal carcinoma. Bi-Rads Category 4. Is cancer probable with these findings and a bi-rad 4 ?. What is the % that it's cancer? I just want to be prepared for the biopsy findings.
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242527 tn?1292452740
Dear miztp:  Microcalcifications are small calcium deposits found within the breast tissue. There are different types of microcalcifications, and based on their pattern on the mammogram it gives the radiologist clues as to their cause. For instance microcalcifications that are more scattered are probably due to a benign (non-cancerous) cause, a “cluster” of microcalcifications may increase concern that there may be an underlying tumor. There may or may not be any 'lesion' visible on mammography. However, if the microcalcificantions appear suspicious, further investigation, such as a biopsy, is usually recommended.  A BIRAD category 4 means that there is a suspicious abnormality. Most category 4 abnormalities are benign but may require biopsy since this category can be malignant in 25-50% of cases.  
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I had just about the same mammo results as you, BIRAD4. My surgeon (in April of 2006) advised that 15% of these turn out to be malignant--85% are not.  I was one of the unlucky ones, but lucky in that I caught my cancer EARLY.  Good luck!
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25201 tn?1255584436
I believe in the past it has been stated on this Forum that 25 - 50% of BIRAD 4 rating can be something OTHER than a malignancy. Wait for the response from the Professional though which will no doubt be posted tomorrow (8/3).
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I am one of the fortunate ones with 2  biopsies for somewhat pleiomorphic microcalcifications, BIRAD 4 turning out benign. On my report they also wrote "cannot rule out malignancy." They won't know until they do the biopsy if it's cancer or not, but the chances of the calcs being benign are in your favor. I hope you join the benign group.
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My info says 85% of calcifications are benign. But, according to California Pacific Med Center, about one out of four women with calcifications thought to be concerning enough to warrant a biopsy, has a breast cancer, usually at an early stage. This info helps me understand the difference in statistics quoted.
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On my mammo last week a '1.2 cm shadow' is seen that now requires a spot compression and possibly an US. I'm unfamiliar with spot compression...obviously it gives the radiologist a better view than the mammo, but is it used to looked for microcalcs? It's hard not to jump to possible outcomes while I wait. I know you all understand. : )
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Spot compression takes a closer look at an area that is unclear or suspicious. I believe it refers to a magnified view of a small area. They often use magnified views for calcifications. But sometimes breast tissue folds over on itself causing distortion, calling for more views. It's pretty common to follow up spot compression with magnifications. From that they'll decide if you need a biopsy or possibly the spot compression will clear it up and they'll decide all is fine. Cyn, were you at this site with breast problems some months ago or am I confusing you with someone else?
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It's me. I went through a hellish summer last year which resulted in 3 biopsies (all benign) and a whopping hematoma. : ) Since then, I had an US in Feb on the right breast for 4 cysts (no follow up needed at this time) and a mammo on the left side in May for a new lump (cyst). Now in July, had my yearly mammo for which I got the call back for spot compression. I go in on the 10th. I'm doing fine mentally...just wish I didn't continue needing screenings. In march I also had a biopsy of the lining of my uterus (benign).

I have conflicting feelings about screening...sometimes it feels over done, and yet I'd rather have something caught early. Given the very real fight so many woman are waging against bc puts everything in perspective.
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Hello All,

This is my first time being on this site and it has been truly insightful so far. I am a 33 year old female that found a lump in my breast. After the mammogram (VERY painful) and ultrasound, a 1 cm lump was indicated. The ultrasound findings indicate "an area of palpable abnormality 4 cm from the nipple. This is a suggestion there is some enhancement posteriorly suggesting this may represent a complex cyst.Would first advise that attmepted cyst aspiration be obtained and if no fluid is aspirated, core biopsy be obtained subsequently under ultrasound guidance. IMPRESSION; Well defined density in the right breast in the area of palpable abnormality, either representing a complex cyst or solid mass. Suggest ultrasound cyst aspiration be attemped, and if no fluid is aspirated, ore biopsy be obtained. BI-RAD Code 4: suspicious abnormaility - biopsy should be considered."

My biopsy is scheduled this coming Monday and I am very fearful of the outcome. No history of any breast related cancer or any other cancer for that matter in the immediate family. A couple of days after the mammogram, I started experiencing a burning sensation on the opposite side of where the lump is as well as some burning sensation on the other breast (no lumps in the left breast). The burning sensation has not gone away and it's been about 7 days since the testing. I don't know what to think at this point. If fluid is aspirated, then does that mean this is cyst related and not cancer? Why do I feel a burning sensation still?

I am very scared so anyone out there, wish me luck, pray (if you pray) for me and if anyone can answer my questions, i would greatly appreciate any feedback i could get.

Thanks!
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I will be thinking of you. What you describe occurs often in women, though I know it's still not easy to go through. I've been through the same procedure many times with benign results for all. I've had complex cysts that both could and could not be aspirated. Stay strong and let us know how it goes for you.
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Hi Cyn17,

I appreciate your response and well wishes. This really is a difficult time and the waiting is excruciating! I appreciate you informing me that complex cysts can have the possibility of not being aspirated. I helps me to understand that no matter what, I will have to wait for results. I wonder though..if it is aspirated does it mean it was definitely a cyst or still can't tell. I'm sorry you went through it 4 times! That must have been tough. I too had some abnormalities in the cervix which required me to have cyrotherapy to freeze the abnormal cells out. So far I'm ok there, but what the heck?? How much more can we handle of this stuff? :)

I wish you well on your test on the 10th. I will be thinking of you as well. Sending positive vibes....
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Cyn, if it's calcifications they're looking at, is it possible they are a result of your previous biopsies? Are they in the same quadrant of your breast as your previous biopsies? After my 3 benign biopsies I really started questioning my need for more biopsies since they're always in the same quadrant. So now every 6 months I end up having a radiologist read my mammos who says I need a biopsy. Then I ask Dr. Anderson, my preferred radiologist to read my mammos and he always feels the calcs are benign. My surgeon feels Dr. Anderson is more experienced and agrees that after 3 benign biopsies in that area my calcs are probably benign. They still emphasize the need for me to have a mammo and CBE every 6 months because, of course, there is no guarantee that they are benign and feel I need to be watched closely.


I think radiogists are often over cautious, especially if they are inexperienced. But I agree with you that it is important to catch things early. It is stressful to go through this constantly... Are you seeing a breast specialist or general surgeon? Can you go to one of the large teaching hospitals for a second opinion of they suggest another biopsy?
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Sorry to hear you have to go through this, too. I usually have pains in my breasts after mammogram and after a very thorough (and painful) CBE. They usually go away little by little. Breast cancer is not usually painful, but it is occasionally. And, remember that a high percentage of BIRAD 4 biopsies are benign. But, you won't know unless you have a biopsy. I know how hard it is to wait for the results. I wish you the best.
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This new finding is in an area unrelated to the other biopsies. Today while taking a bath, I rubbed soap over the area and I can feel the lump I believe they are concerned with. I have such lumpy breasts that I've begun to rely on mammos and US to catch the lumps, otherwise I'd be at the doctors every few months with concerns. : )

I go to a very reputable hospital in Boulder, CO, with a new cancer center to boot (let's hope I never see the inside of that facility). After the craziness I went through last year, I changed doctors, breast surgeon and facility and have been very happy with my care since the change.

I was reading some else's post from last year stating they've never had a normal mammogram. Neither have I. In the past I thought they were being very conservative because my mother had bc, but reading everyone's experiences, what we're all going through sounds like the norm. Crazy!
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lcrisp - If they aspirate your cyst they will check for abnormal cells in the fluid. If they can't aspirate it, it may be a fibroadenoma which they will remove with a core needle biopsy and test the tissue for abnormal cells. So yes, more waiting. In most cases cysts and fibroadenomas are benign.

Also, the burning you feel may be the pressure of the cyst or inflamation of your breast tissue around the cyst. Once it's drained or removed, you probably won't feel the burning anymore.

When do you go in again?

Positive thoughts back at you... : )
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I appreciate your input as well. This is a fantastic forum! I have read on a number of different websites that breast cancer is typically not painful. I think though, no matter how much I read it there is always this doubt in my head that I'm one of the few. Anyway, thanks for the well wishes and I also wish you well too. Another lump? Geez...I'm really sorry and hope for the best~

When do you go to find out?
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Hi Cyn17,

My biopsy is scheduled for tomorrow, Monday August 6th at 9 a.m. I just hope that since it will be pretty early, it's sent to the lab early and that I have an idea of what I'm dealing with by Wednesday. Also the burning pain I feel is mostly in the right breast but also in the left as well, so I'm thinking that makes sense. It's a little more painful on the right though. Anyway, I will keep you posted and probably check in again tomorrow just to let you know how it goes.

Thanks so much to both of you (Montana girl included) for responding. It has truly helped me feel a little more positive. :)
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I'm so glad you have a surgeon and breast center you trust. I don't have a true breast center anywhere nearby, but I do have a surgeon and radiologist I trust, so I'm ok with that for now. Where are you in the long process of getting to the bottom of your problem? Are you waiting for results of the spot compression?
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Like cyn, I have to rely on mammograms and ultrasound to tell what is normal and what is not in my breast. I have so many lumps I don't know what's a lump, what is scar tissue from previous biopsies, and what is just my regular lumpy tissue. I go every 6 months with my next appt in October.

I hope your biopsy goes well tomorrow. You're in my prayers. Please let us know your results.
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I don't have the spot compression until Friday, 8/10. Unfortunately I have to travel for business early this week so I had to schedule the follow up for the end of the week. I'll let you know how it goes.

lcrisp - all the best to you in the morning. Please keep us posted.
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