are microcalcifications Amorphous, Heterogeneous?

Hi
    The radiologist did not label my microcalcificatios, but gave them a Birad of 4. Can anyone tell from the description she gave wether they are Amorphous, Heterogeneous or Pleomorphic, (which I doubt cause that would be a Birad 5)?
She said I have "2 adjacent groups of microcalcifications and although they are relatively coarse they are variable in  size and shape. Many are rounded." I can not seem to find clear definitions of those words above to see if any fit my microcalcificatios.
    I'm not worried because I feel like the odds are so good that it's nothing; but I'm curious.
                                 Thank you to anyone who responds.

[japdip]

In my opinion the only thing you would need to know from the report is that you need to have some type to biopsy to determine the exact nature of these calcifications; whether malignant or benign. Every Radiologist may use different terms to describe what they see on film and we only need to follow the recommendations rather that research beyond what is evident as demonstrated by the testing.  Good luck with your biopsy .....

[RTRM321]

I agree with japdip above.  Radiologists can describe things slightly differently regarding calcifications, but the main thing is a biopsy is recommended.  A Category 5 would mean "Highly Suspicious", and obviously that is not the case per the Radiologist.  If one of the Radiologists I work with were to read your report that way....In my opinion, coarse and round are good words to use, but "groups of calcifications" would raise suspicion and need biopsied.  Microcalcifications can be a benign process OR the beginnings of a malignancy....and it can be hard to tell when they are soooooo small!
Microcalcs are fine if they live alone or are scattered about in the breast, but if they start to grow into a cluster or group together or have a powdery appearance, the Radiologist recommends biopsy.  Please try not to worry, as most biopsies come out benign.   I hope this helped!!

[Teddy1982]

       Thank you for the post. The part I felt unclear about was the variable shapes and sizes. I was a little surprised at japdip's statement above "we only need to follow the recommendations rather that research beyond what is evident as demonstrated by the testing." Everyone on here who has had an abnormal mamm is here because they are doing research. I thought that was what we were supposed to do.
      Why are radiologists using their own terms to describe microcalcifications? Shouldn't they be using the terms that all ready exist so patients understand? It seems to me that using standard terms would be a good thing.
      I am NOT worried about what the results would be from a biopsy as most are benign. It's hard for me to feel like an 80% chance of benign is something to rush in to. I would like to understand my mamm better so I can make a decision about having a biopsy. I have had many medical problems since I was a child. I was put through a lot of miserable tests. So I don't jump when drs say jump. I need to have a good reason to have a test. I like to do research to understand the necessity of what is recommended. I asked the radiologist what my alternatives were and she said I could wait 6 mths. So I am trying to make an educated decision.
      I understand that different shapes hold different percentages of concern. Understanding that would affect my decision. I asked if I should get a 2nd opinion on mamm and was told they will all say the same thing. Obviously, no one wants to go against the original report. I will have to decide rather to do a biopsy or wait based on other things. I guess from the answers above, the radiologist was unclear enough that no one can answer my question. Thanks for trying.
     Btw, I have 3 children with serious medical problems, including one who is autistic. Plus my husband suffered a head injury a few months ago. He is supposed to recover eventually but right now it's rough. I am feeling overwhelmed trying to take care of everything. Dealing with a breast biopsy that I'm sure is going to be fine seems like to much right now. (Had to have a uterine biopsy, ultrasounds etc in Apr; all for nothing. No, it wasn't for peace of mind as I was not worried about it either. But was a lot to deal with all those appts.) I don't want to make the wrong decision but I don't want one more thing on my plate if it's not necessary right this minute.
     I guess no one can help me decide what is best for me in this situation. I really appreciate that you tried. Thank you.
    
    
    
      

[japdip]

Just a couple of quick comments .... the research subject; unless one has an advanced medical education it is not always wise to do too much research. Most conclusions are made using vast groups of patients and rarely are any of us alike. It only serves to confuse and make a person think way beyond where we should be at the moment. A second opinion is always wise IF you have doubts about the 1st. The report need not (and should not) be included when you seek a 2nd opinion. Only the films and that would mean you would take your films (ONLY) to another Radiologist at another institution to be read. One thing I don't quite understand is what decision you have to make at this point .... a biopsy has been recommended because the radiologist cannot determine with 100% accuracy what has been found on film .... this is GOOD MEDICAL PRACTICE ... as far as I'm concerned no guessing is allowed when it comes to my health. By all means get those films read by someone else; perhaps at a Breast Center if one is nearby or call and have them request your films for a second opinion. I personally would NOT spend too much time putting off the biopsy though. Kindest regards ....

[RTRM321]

I found this under BIRADS_Mammography....

"Sometimes, a single descriptor will not be
adequate to characterize a finding. This is often
true with calcifications and margin characteristics.
Calcifications may include several different
types; for example, punctate and amorphous. If
one type predominates, a single descriptor may
be best; if not, multiple descriptors may be
preferred. One must remember that management
recommendations should be based on the most
worrisome of the features. For calcifications, it
may be the distribution or the morphology. While
more than one feature may be described, a single
management recommendation will be made based
on the most suspicious feature(s). Thus, a cluster
of pleomorphic and punctate calcifications may
use all terms needed to describe the calcifications
with a statement recommending biopsy be considered
due to the presence of pleomorphic forms.
One may also describe the finding as a cluster of
microcalcifications with pleomorphic forms and
biopsy should be considered. This flexibility
should also be carried over when describing margins.
Many margins will be partially obscured by
glandular tissue. If at least 75% of the margin is
circumscribed and the remainder is obscured, the
mass can be classified on the basis of its circumscribed
margins. If, however, a mass margin is
partially circumscribed and partially indistinct, it
2 American College of Radiology
Fourth Edition – 2003
should be classified on the basis of its indistinct
margins."

That was a bit long!  Radiologists do not use their "own terms".  They use general known terms to describe what they see.   I have been a Mammogram Tech for 15 years and personally, I think if the Rad recommends a biopsy for calcifications, it should be done. Sometimes after additional magnification views have been done, the Radiologist can certainly identify them as benign appearing, but in your case, the Radiologist cannot determine that for certain, therefore recommending biopsy.
I understand your frustration of yet another medical procedure upon yourself or family member, but I have seen patients wait 6 months, and then if the group of calcifications have grown, then a biopsy is definately needed, and it may have allowed a cancer to grow.  A stereotactic core biopsy isn't too bad of a procedure, and you will go home the same day.  You will still be able to tend to your family.  You are right that no one can help you decide what is best for yourself, but remember that you need to stay healthy in order to care for your family.
Good luck with your decision.....:)

[bluebutterfly2222]

A BI-RADS 4 does NOT mean an 80% chance of a benign finding.  It can encompass a 2% up to 95% chance of malignancy.  Below are the explanations from the Radiology Assistant Web site.  (The site has pictures of actual mammograms illustrating the different kinds of calcifications. Send me a PM if you would like the link.)
-----------------------------------------------------------------------------------------------------------------------
Final Assessment Categories
  A negative diagnostic examination is one that is negative, with a benign or probably benign finding (BI-RADS 1, 2 or 3).
In BI-RADS 3 the radiologist prefers to establish the stability of a lesion by short term follow-up.
In the evaluation of your BI-RADS 3 lesions the malignancy rate should be  95%.
---------------------------------------------------------------------------------------------------------------------------

As you can see, both BI-RADS 4 and  5 REQUIRE a tissue diagnosis, and a BI-RADS 4 means the radiologist has sufficient concern to URGE  a biopsy.  As RTRM321 pointed out, it is important that you take care of yourself, in order to make sure that you will be able to continue taking care of your family.

Best wishes...

[bluebutterfly2222]

Correction!! Please ignore the information between the lines above!!

Somehow, a big chunk from the middle part of the information disappeared before it posted (????), causing part of what remained to be totally incorrect...

I am repeating the correct information in its entirety below:
-------------------------------------------------------------------------------------------------------------
Final Assessment Categories
  A negative diagnostic examination is one that is negative, with a benign or probably benign finding (BI-RADS 1, 2 or 3).
In BI-RADS 3 the radiologist prefers to establish the stability of a lesion by short term follow-up.
In the evaluation of your BI-RADS 3 lesions the malignancy rate should be  95%.
---------------------------------------------------------------------------------------------------------------------

I reget any inconvenience or alarm that may have have been caused for anyone by this
inadvertent error.

bluebutterfly

[bluebutterfly2222]

Oh, no!! It happened again!!  :-(

Apparently there is some strange glitch in copying and pasting the information from that Web page... This time I'm going to try typing it all out myself. (Wish me luck!)

Final Assessment Categories

A negative diagnostic examination is one that is negative, with a benign or probably benign finding (BI-RADS 1, 2 or 3).
In BI-RADS 3 the radioligist prefers to establish the stability of a lesion by short-term follow-up.
In the evaluation of your BI-RADS 3 lesions, the malignancy rate should be less than 2%.


A positive diagnostic examination is one that requires tissue diagnosis (BI-RADS 4 and 5).
In BI-RADS 4, the radiologist has sufficient concern to urge a biopsy (2-95% chance of malignancy).
In BI-RADS 5 the chance of malignancy should be greater than 95%.

[RTRM321]

Above is perfect!! :)  And to add to that a BI-RAD Category 4 has 3 levels of suspicion

4a-low suspicion
4b-moderate suspicion
4c-high suspicion

5-Highly suggestive of malignancy

[Teddy1982]

     I will admit to being math challenged, so forgive me for being confused.   :-)     In birads 4 there is a 2%-95% chance of malignancy right? But of all biopsies done, only 20% are malignant. So doesn't that mean that the chance of a malignancy is only 20% ? Therefore chance it's benign is 80% ?
     It's obvious I'm missing what you are trying to tell me. Sorry.
     The rad did not rate it a,b or c. I'll call tomorrow and ask for a 2nd opinion and rather it's an a, b, or c.
     I'm sorry I seem like I'm being stubborn. I'm not afraid to have the test, ( tho a little anxious since I can't stand laying on my stomach) or even worried about the results, (cause I thought it's an 80% chance it's benign). It's that with my husbands head injury, I'm trying to deal with everything, (including our autistic son who has been screaming all day), by myself. My husband is usully very supportive. But right now he's too sick. Adding the biopsy to the mix feels like to much weight on my shoulders right now. Due to things beyond my control, I don't have anyone to talk this over with. You guys have been helpful. I have the biopsy set up for June 28th. I'm going to keep the appt and hope that by then I can handle it.
      Thank you so much for listening.
    

[bluebutterfly2222]

No, I don't think you are being stubborn. I think you are just trying to gather all the information you need to feel comfortable making an important decision in regard to your health. (We are not here to judge, just to inform, help, and support each other.)

The different statistics do sound confusing, but that's because they actually refer to two different things:

1. For a radiogist to call a specific image a BI-RADS 4, the chance of THAT LESION being malignant should, in his/her estimation, based on his/her training and experience, be  at least 2%, but not more than 95%. (The level of suspicion within BI-RADS 4 is sometimes further subdivided, as RTRM321 mentioned.)

2. However, the overall results for  BI-RADS 4 biopsies, AS A GROUP, are often quoted as 80% benign findings.  (That would be possible, of course, only if the majority of them were in the lower range of suspicion and/or actually proved to be benign, and there were fewer that appeared highly suspicious and/or proved to be malignant, included in that category.)

I hope this makes things a little cleared.

Regards,
bluebutterfly

[katarina777]

You know bb, and this is surely not meant to discount any of the data you have shared, but to me none of this makes any sense at all! If a radiologist judges a BIRAD 4 to be anything that has more than a  5% chance of beong malignant,  but less  than a 95% chance of being such, then why would he need to go to school at all. you could grab any kid from Kindergarten and his/her impresssion would most likely be just as good.

For me, I got a BIRAD 5, but not one single involved person, well except for the radiologist on location at the time, let me believe anything than what I thought myself, and that this was definitely, 99% sure, a nasty , malignant cancer. Even when I asked the technician if it was bad, only half serious as I did not expect an answer, she said 'yes, very bad'. (The radiologist was so wishy washy, it was disgusting, utterly) The surgeon who did the biopsy told me also he was more than 99% sure this was malignant cancer just from what he saw from the films and exam.

So, for a 4, I could understand (and I really mean 'I') if maybe a 4 meant that the radiologist thought there was perhaps more than a 50%  chance of malignancy, but it sounds really weird if based on his schooling, and training and experience, he/she believes  the answer is somewhere between  5 and 95%?

What do you think about the information? Kat

[RTRM321]

The information makes sense to me, but then again I know this "language".  
Overall, 80-85% of biopsies are benign (given 100 biopsies, 15 - 20 would be malignant, and 80-85 would be benign).
As an individual patients assessment, the mammogram report is given a BI-RAD number on level of assessement....

From the ACR Bi Rad site.....

Category 1: Negative, there is a 5/10,000 chance of cancer being present. Continue annual screening mammography (for women 40 and older).

Category 2: Benign (non-cancerous) finding, same statistics and plan of follow-up as level 1. This category is for cases that have a finding that is characteristically benign such as cyst or fibroadenoma (see below for more detail).

Category 3: Probably benign finding, there is less than 2% chance of cancer. Usually receives a 6 month follow-up mammogram; most level 3 abnormalities do not receive biopsy.  

Category 4: Suspicious abnormality. Most category 4 abnormalities are benign but may require biopsy since this category can be malignant in 25-50% of cases.

Category 5: Highly suggestive of malignancy. Classic signs of cancer are seen on the mammogram. All category 5 abnormalities typically receive biopsy and if the biopsy results are benign, the abnormality usually receives re-biopsy since the first biopsy may not have sampled the correct area. Depending on how individual radiologists differentiate between category 4 and 5, the percentage of category 5 abnormalities that will be cancer may vary between 75% and 99%.

I hope this helps.

[bluebutterfly2222]

I probably never should have intoduced the suspicion range for each BI-RADS category, since it just seems to be confusing people, although RTRM321's post  probably helped to clarify it.

The only reason I brought it up was that Teddy commented that she saw no reason to rush into a biopsy when the chances were 80% that it would be benign.   I was concerned that EVERYONE would think their individual risk for a malignant report would be only 20%, whereas as you can see from the post above, the risk varies widely when it comes to individual cases.

To put it in a different context, riding motorcycles can be a rather risky activity. For the sake of argument, let's say 20% of the riders (1 in 5) are likely to be involved in a serious accident.

But as we think about different motorcycle riders we know, it's pretty obvious that the grandpa who takes his grandchild around the block in a sidecar on his "put-put" motorcycle once a week probably has a far lower than average  risk , while someone who rides a powerful bike, speeds, engages in all kinds of tricks including jumping over canyons or rows of cars on a daily basis obviously has a much higher than average risk.

And that was my point: Averages can't be counted on, in the case of any specific individual.

[bluebutterfly2222]

Kat,

Sooooo sorry that yours turned out to be the "Evel Knievel" of tumors...  :-(

♥♥,
bb

[zouzi]

Very good comment bb, my concern about the percentage was the same as yours.
The important thing now,is that Teddy has taken the decision to proceed with the biopsy the 28th,and I am sure that we are all pleased about it.

Teddy,this is the best decision you could take,having the biopsy will give you the peace of mind that you would not have had,if you had decided otherwise.No one of us like or find it pleasant to go through these medical procedure,but when we face risks concerning our health,it's always better to be reassured by doing whatever is needed to keep healthy and safe.
As members in this Forum we all try our best to help each other by giving,(to the best of our knowledge) the best advice possible...and we do this out of concern and because we care very much for each other.
Please let us know how things are proceeding .We all wish you the very best and may the results of your biopsy turn out"BENIGN".
Take care now, and God Bless....

[Teddy1982]

     Thank you all for the posts. It has helped a lot. Nice illustration about the motorcycle bluebutterfly2222. I understand what you are saying. The ratings within the birad 4 helped too, RTRM321. So within the # 4 you have varying chances of malignancy based on the level of suspicion for each individual.
     To clarify, I have had the June 28th appt since May. I have NOT decided to actually do it on that date. I called the mamm office today and asked to have it looked at again with the addition of a rating:
4a-low suspicion
4b-moderate suspicion
4c-high suspicion
     I explained that I was trying to decide how QUICKLY to have the biopsy because of my husband's illness. She was very nice. She said that a rad would look at it today or tomorrow and call me with their results. I will let you know what they say.
     My reason for possibly waiting is because of how sick my husband is. It's not because of fear of the biopsy or its results. It's because I'm caring for so many family members with serious illnesses that I am in overwhelm. I know I need to stay healthy for them. But if the pressure of all these things breaks me, I won't be able to care for them. Being a primary caretaker of my very ill kids for 22 yrs has taught me that when I am overwhelmed, it will eventually get better. I will feel better and be able to handle what comes next.
     So if the suspicion is low, I may put it off a FEW weeks. If it is high, I will try to reach even further inside and summon the emotional energy and do it on the 28th. Either way, I PROMISE I will get the biopsy. You have all convinced me to do it.
     I will post the rad's evaluation when I get it.
              THANK YOU ALL SO MUCH
    
    

[bluebutterfly2222]

Thanks for you kind comments.

It sounds as though you understand your limits in regard to the demands of your family situation very well.

The idea of asking for clarification regarding  how suspicious (or how nonsuspicious) the radiologist considers your image sounds like a good plan.

We are just happy that you are going to be sure to take  care of YOURSELF, either sooner or later, as the situation dictates.

Since you are carrying so many responsibilities, apparently with little help or support, you might want to consider posting in some of the other support communities on MedHelp,  related to the issues you are dealing with.

We'll look forward to hearing from you again with an update.

Best wishes,
bluebutterfly

[bluebutterfly2222]

p.s. I just checked, and there is even a caregivers' support community.

bb

[katarina777]

Thanks, bb, for explaining again. I also understand this better now, and I also loved the motorcycle metaphor. Kat

[katarina777]

And in my case, it was such an easy case,or 5, I guess, because the signs and symptoms were clinically so obvious. Highly visible and highly palpable. Even I could not deny that it was there, although I had never for a second in my life  worried about bc. I 'knew' I would never get cancer!! (smile) Nobody ever  had in my family.

[RTRM321]

Glad to try and help!  Keep your spirits up and let us know what the rad's reevaluation says!

[ncmichigan]

Hi, Teddy,
I just wanted to add my best wishes to you, too. You have SO much going on you make my 3 biopsies seem like a piece of cake! My last one was for microcalcs and coincidently found LCIS, so I'm glad that I had it. But I can certainly understand your
need to postpone it a bit if possible. Hopefully, clarification from the radiologist regarding the level of suspicion will put your mind at ease a litttle until you can get the biopsy.
When you do have it, I hope that maybe there's some support out there for you from other family or friends. Please don't be afraid to ask---you health and emotional well-being are important, too!
I sincerely hope your husband makes some improvement and that things work out with your biopsy. Wishing you benign results and sending you a big hug (     ),
nc

[Teddy1982]

     The rad who originally read my mamm called this morning. She said her gut feeling is that it's fine. She said most of the microcalcifications are round and my breasts are not dense so she doesn't think there is a hidden mass. Plus, she said if it is cancer, it is usually so slow growing it won't hurt to wait.
     Her reasons for reccomending a biopsy were Some microcalcificaions were not round, there were 2 clusters, and there were no other mamms to compare it with. She said I could wait a while and still do the biopsy or wait 4 mths and do another mamm, (it's already been 2 mths since the 1st mamm. So that'll be Nov.
    It was nice to have this additional information. I will now have to decide what to do. I'll be interested to see what you all think about what she said. Does it make sense to you?
    Thank you all so much for hanging in there with me. I have already been on the head injury community and I will try the caregivers community. Thanks for the suggestion.
    Btw, my husband is doing a little better. A concussion dr perscribed a med to help improve brain function and it seems to be helping. Yay!!
    You girls are the best! Thanks!

[bluebutterfly2222]

I think it would be safe to follow the radiologist'sadvice, esp.since she gave you detailed info about her observations and  thought porocess.

So glad your husband is improving!

Best wishes for your whole famlty, and please stay in touch--we care!

bluebutterfly

[RTRM321]

Thanks for the update!  I am so glad the Radiologist spoke to you and gave you her opinion!  It makes sense to me!!   Many patients do have early follow-ups as opposed to having a biopsy (it all depends on the level of suspicion).  As she had no prior mammograms to compare to, I can understand why she had to recommend a biopsy.  If the calcs don't change after 6 months, and remain stable, that would be a good thing!  

I am happy your husband is feeling a bit better too!  Hoping time will help him heal :)

[ncmichigan]

Hi, Teddy,
The additional information from the radiologist sounds very sensible. At least you have a good basis to make your decision. With a first mammogram, any findings other than
normal can be difficult to evaluate, but your radiologist sounds like a thorough, professional and compassionate physician.
It's also wonderful news that your husband is doing better! Hopefully, he'll continue to improve with time. Whatever decision you make, I wish you all the best and benign results. Please keep us updated if you wish. Here's another hug big (      ),
nc

[isabailey]

i cant imagine going thru all that you are dealing with.....when it rains it pours.  my thoughts and prayers are with you and your family.  

isabailey

[SueYoung55]

I got lost here in these posts. Who's on first???  LOL

From what I gathered you have your hands MORE than full at home. You seem to be able to organize with all the confusion going on around you which is a talent all by itself. Good for you! Remember, you are your own best advocate and you are surrounded by some very fierce women here and it looks like they have your back! :)

Best wishes.