birad 4 microcalcifications biopsy?

If anyone can help with my question I would be so grateful.  I had 2 mammograms that confirmed microcalcification clusters in my right breast at 9:00 (is that my 9:00 or his?), anyway, one surgeon told me to have another mammogram in 3 months or a biopsy.  Another surgeon who has been my family and friend's doctor for years with a great reputation told me he would do a surgical biopsy removing the calcifications and surrending tissue so as to test everything and not leave anything behind.  He said that he first inserts blue dye and then removes the dyed area.  I have not read anything like this on this forum or anywhere in the internet when I research.  Can anyone explain if this is common?  I trust this man, but want to research myself as it is my body and my decision.  Thank you so much.

[lizziecee]

Hi - I too have never heard of injecting a blue dye in order to do a surgical biopsy. When I had a 2 cm invasive ductal carcinoma 4 years ago, the radiologist injected the area with local anaesthetic(using the ultrasound scan screen)  and the core biopsy procedure was painless. 2 yrs later, I had a long ropey lump in a different area of the same breast  (turned out to be benign Mondor's disease) and the procedure was the same. I would ask your surgeon some detailed questions... is this a new procedure? why blue dye? Seems strange to me, but perhaps I am out of date. A surgical biopsy may be different to my two core biopsies. Hopefully someone else will come along with more information/experience than I have.

I would seek an opinion from a specialist breast surgeon at a major university hospital, if one is available in your area. You could try calling the Susan G. Komen Foundation and ask their opinion.  General surgeons are not usually experts in breast cancer. A biopsy is the only conclusive way to determine if cancer is present or not.

Good luck
Liz.

[txgrl01]

I never heard of blue dye for the breast biopsy.  I had an excisional breast biopsy in July.  In August, blue dye and a radioactive tracer was used for my sentinel node biopsy.  Ask the surgeon to explain more fully and ask for literature to read.  God Bless.

[Rtist]

Thank you so much for your answers.  I did some research myself and saw he is doing a wire localization procedure where they insert blue dye to identify the microcalcifications.  Again, I guess it is his way.  He is a breast surgeon who specializes in breast cancer.  He circled a part of a pamphlet he gave me that was about it.  The pamphlet is up to date with its date of publication.  I just still never heard of the blue dye.  Txgrl, I too heard of using it with the sentinel node biopsy.  I am going to have it on the 26 of October.  How are both of you doing now.  I will research with Susan G. Komen Foundation too.  Can you tell me where 9:00 is?  On my right breast is it on the outside or inside.  Thank you again.

[lizziecee]

Apologies for thinking your surgeon was a general one. I would assume 9.00 is on the outer side of the breast, horizontal with your nipple?

Thanks for asking about us. I am doing fine with bc, 5 yrly check up and mammo next Jan. Otherwise, not too good. I have Crohn's and gastro found a stricture (narrowing) in my small intestine which may be the cause of the current inflammation, diarrhea and weight loss of some 10 lbs in a month. He has ordered an MRI to determine if it has gotten worse since the endoscopy 5 months ago. Said I have to be prepared for surgery to resect the stricture as if it gets worse it will burst and cause sepsis. Must say I have found Crohn's to be more difficult to deal with than breast cancer.  I had the works: lumpectomy, total axillary removal, chemo and rads, but we seem to have beaten it at the moment. Wish there was a simple solution for Crohn's, but at the moment it is trial and error. I have been on self injected chemo (methotrexate) for some 6 yrs now, with a break for FEC chemo for bc.  

Hope your biopsy is benign - do come back and let us know how you got on and if we can help.
Liz.

Liz.

[Rtist]

I'm so sorry about your Crohns.  I know about the disease and how it causes such pain and interference in one's life.  You seem to have had your share and I'm sure outlets like this forum where you can help others is helping you cope and feel strong.  With your breast cancer, how did they find it and what were the first steps in the process of diagnosis and treatment.  What initially was seen on the mammogram.  I'm so glad you are doing well with your bc.  Lets just hope they can fix whatever is going on with your crohns and give you some peace and comfort.

[lizziecee]

Thank you for your kind words. Helping others with bc and Crohn's does bring some comfort, as when I was dx with Crohn's 37 yrs ago, hardly anyone had heard of it - including doctors.

BC - interesting you ask how it was diagnosed as it was somewhat unusual.  I went for my 3 yrly mammo (in England we only get them 3 yrly, and 2 yrly after bc) and didn't suspect anything was wrong. This was at a travelling unit.  About 4 weeks later I was sent a letter recalling me to a hospital in the nearest large city. I just thougt that perhaps the x-ray film was dirty - I had no palpable lump, but did have intermittent pains down my right arm, from armpit to wrist. The hospital I went to is one of only 6 centres of breast care excellence in England, so I felt I was getting good care.  

When I went into the x-ray room, the radiographer had my initial mammo up on the light box and I could see a large black mass that was spiculated like a starburst. I didn't know then, but a spiculated mass more often than not, means the lump is cancerous, but I can recall that moment vividly, and knew I had cancer.  The tech did a compression mammo, sent me back to the waiting room. Then she came back and asked my husband and I to go into another room where I was introduced to the Director of the BC Clinic, Dr. Jones who is a radiologist.  She did an ultrasound, showed us the mass, and asked if she could do a core biopsy, with local anaesthetic. It didn't hurt at all.

We were then taken into an office room, given tea in china cups and the Director introduced us to a breast care nurse. We really knew something serious was afoot as we have never had tea in bone china cups on the National Health Service before.  The told me I had a 2 cm tumour (never mentioned the word cancer) and the tissue from the biopsy would go to the pathology dept and they would call me when they had the results. They already had a date for surgery!! They asked if I wanted a mastectomy without radiotherapy or a wide local excision (lumpectomy) with rx. I opted for the latter.  I was called back 4 days later and got the bad news. I had the WLE and sample node removal,which again had to be looked at by the path lab. The tumour was invasive ductal, but more disturbing was that I also had DCIS, both cribriform and comedo, and 3/8 nodes were positive for cancer. Back in another month for total axillary removal - far worse than the WLE. One more node was positive. This was when they first mentioned chemo, since the cancer had already spread to the lymph nodes, and could have also spread to other organs, like the liver,lungs or bones. I had a CT scan, bone scan and chest x-ray and all were clear.

I had a dreadful time on FEC chemo. I had to stop taking my normal chemo (methotrexate) so naturally the Crohn's flared. I eventually found a compassionate female GP who worked one morning a week in the Oncology Dept and she prescribed a small daily dose of dexamethasone. However I was faecally incontinent - a few times in the street which was so humiliating and embarrassing I stopped going out other than my 3 weekly visits to the hospital for chemo. I couldn't eat any solid food, so she prescribed Frutijuice which was sent from the hospital pharmacy to my home. I had to drink 3 cartons a day, each of 300 calories.  The Frutijuice had all the minerals and nutrients to keep me alive. I lost about 28 lbs during that time but was determined to get through it. I then had to go into hospital for 5 days to sort out rectal haemorrhaging from burst abscesses in my colon. When that was all over, I started 5 and a half weeks of radiotherapy.  I am due for my 5 yr review and check up in Jan and as far as I am aware, I am in remission. My bc surgeon told me I will probably die from Crohn's rather than bc, and I thought he was joking to make me feel better about bc!

Sorry to be so long winded.......you did ask!
Take care,
Liz.

[txgrl01]

The clock would be as the doctor looks at it.  If its 9:00 on your right breast that would be out from the nipple toward your right arm.

I healed very fast after my unilateral mastectomy.  A followup MRI found a problem in the left breast and am now waiting for the biopsy results.  My newest mantra is "false positive, false positve, false positive."  :)  
I should also have my Oncotype DX results back this week so I'm hoping they will say no chemo.
Waiting...sigh.  

Praying that your biopsy goes well.  I had a wire localization and bounced back pretty well from it.  Was back at work in five days but the last two included the weekend.  Just remember that gravity is not your friend, wear a good front clasp sport bra and support your breast when you have to bend over.  God Bless

[Rtist]

Hello from across the pond.  Wow what a story, you have been through it and seem so centered, God Bless you.  I am so happy to hear you are 5 years in remission.  I will pray for you too.  I saw my surgeon today and I think mine will be a walk in the park.  I'm surprised you have mammograms every 3 years, in the states its every year.  I will keep you posted as to how I am doing and the results.  Take care for now...your friend.

[Rtist]

Thank you for info.  I am praying too, false positvie, false positive, false positive.  Keep me posted, I am getting that sports bra and will let you know how I make out from my biopsy scheduled next friday.  You have been a good support to me.  Thank you....GOOD LUCK

[lizziecee]

[bavmoorda]

Hi.  I was told that due to my small breasts I am not eligible for the core needle biopsy (stereotactic) and I must do the open surgical biopsy.    I was considering doing the "wait and see" option instead of getting the biopsy, but it is a gamble.  Any thoughts on all this?  Your input would be greatly appreciated.
Blessings

[lizziecee]

I would think that if a doctor has suggested a biopsy, then he is concerned. The doctor would not suggest a biopsy unless something is out of kilter. Truly, I wouldn't gamble, not for one second. If the lump spreads to your lymph nodes, then you are looking at axillary removal, and I can tell you, this is far more painful post surgery than a lumpectomy or mastectomy.  Even after a lumpectomy for a 2 cm invasive ductal tumour, and DCIS, my scar below the aureole is hardly visible and the breast is not deformed in any way. Your mind will only be put at rest after a biopsy is done, and you have a proper diagnosis. Just my thoughts - others may feel differently.

Take care,
Liz.

[lizziecee]

Hi - yes, the 3 yrly mammos here for women over 50 yrs is worrying. If I thought I would have gotten cancer, I would have paid privately in the intervening years, but hindsight is a great thing. I am also concerned about only getting 2 yrly mammos after bc. My surgeon says it is because of the risks of radiation but I think it is the NHS policy to maximise resources. When I asked him why did I then have five and a half weeks of radiotherapy after chemo, if there is concern over the risks, he just shrugged his shoulders!  As my tumour was not palpable, I am convinced that the cancer would not have spread to the lymph nodes if I had had annual mammos, as the tumour would have been picked up before it had a chance to spread.  If I had been able to feel a lump I would have gone to see my GP right away. However, can't turn the clock back now. My younger friends, some in their 40's are now having private annual mammos since my experience.

Liz.

[txgrl01]

I will be praying for you on Friday.  Let us know how it goes.

Still waiting for my biopsy results.  It's been two days past the time I was told I would have them.  I called yesterday and was told that they aren't in yet.  I hate living in limboland.  Work gets me through the days and my darlin' hubby gets me through the rest.

Use the ice packs often the first 24 hours.  It helps alot with discomfort and bruising. Take care.

[Rtist]

I don't understand the rationale of "risk of radiation from mammogram".  Everything I have read said they are very safe.  Can you tell him you want it anyway?  I hate to suggest that I know better than any doctor, but its your body.  I just have come to care about you and want you taken care of and babied. I am so glad you are in remission and I believe you will be fine and live out a happy life.  I wish that for you my friend.

[Rtist]

I am waiting here with you for your results.  I care.  I too, have a wonderful husband who gives me great support and makes a difference for me.  He went through kidney cancer last year and had his left kidney removed.  Luckily he didn't need any further treatment, but the shock of how fast it happened (he had gout and while doing testing for that found the tumor) and losing one kidney was enough.  I only wish he had a forum like this to go on and talk about it with others going through the same...he was so scared.  We can't believe how prevalant cancer is, but are grateful that their is so many treatments and success stories.  I'm praying that you are one of those success stories.  I got it, ice packs and sports bra...thanks

[Rtist]

I too was given the option of wait and see by one doctor (who seemed to busy for me) and then went to a breast cancer surgeon who explained that he felt I could have the needle biopsy but suggested that he wanted it out (I have microcalcifications in a specific pattern).  I weighed all my options and then made the decision to get it out.  He said he was involved in a lumpectomy study years ago that resulted in breasts filling back in over time and not leaving any change.  He uses a cosmetic close and other I have talked to who used him can't even find their scares.  With cancer I do not believe in wait and see, but it is your body.  I feel you are not sure that is what you want, because you have come here to ask for other's thoughts.  Let us know your decision.  

[lizziecee]

Unfortunately, our nationalised health service does not work like your insurance driven medical services. I have had a mammo within the 2 yr period, but that was because I had a new long ropey lump, which turned out to be Mondor's disease. I did ring a local private hospital last week to enquire the price of a mammo and they said because I have had bc, I must have an ultrasound as well. They wanted $1,000.  My friends in the Midlands pay $160 for private mammos. I guess nothing much is going to happen before my scheduled mammo in Jan/Feb when I will have my annual check up with the surgeon who operated on me. He is the senior bc surgeon at my hospital and well respected, so I can't really argue with him, or demand a mammo. My only concern is that as neither I nor my GP could feel a lump when I got the recall letter, I am afraid that if I get a recurrence, I would not be aware of it. I did mention to him once that friends in the US get annual mammos from 40 yrs, and he said: "well, you can have any test you want in the US, because you have to pay for it". I didn't have answer to that remark - unusually for me!

Good luck for Friday will be thinking of you.

Liz.

Liz.

[Rtist]

I really learn a lot about things from you.  Yes in the US, people pay for their medical insurance and most is offered as a benefit with your job.  The poor can get free health care under our medicaid program and the disbled and old get medicare.  The democratic party is trying to push a national health care program and it does concern me.  They say we should get with the rest of the modern world.  I guess I'm from the motto "if it ain't broken, don't fix it".  You will be fine and you seem to have a good doctor who you trust.  Where are the midlands anyway.  I watch MOST HAUNTED on tv and love seeing all over England.  I so want to visit there.  What area do you live?  My biopsy will be next Friday.  I have one more week to go.  I will make it a good one.  I pray for you.   Robin

[txgrl01]

I finally received my biopsy results.  Benign!  Now I can get back to completing the original treatment with the plastic surgeon.  At last, I feel like life is moving forward again.

Oncotype Dx results also came in.  18.  Right at the edge of intermediate.  12% risk of recurrence in 10 years.  My husband and I talked about it with the onc and I am not opting for chemo.  Just close monitoring and the oh, so lovely tamoxifen and it's interesting side effects.

Still praying for you on Friday.  God Bless

[lizziecee]

txgrl01 - what joyous news! Hope you are celebrating - perhaps with a glass of champagne?

Rtist - I live in an 1850's old Napoleonic Fort on Plymouth Sound, Cornwall - far west of England. It is literally on the water, and being near Plymouth (where the Pilgrim Fathers set sail for the 'New World', we have lots of naval traffic from the nearby Devonport dockyard (frigates, destroyers, nuclear submarines etc.) cross channel ferries to France and Spain, leisure yachts racing, fishermen etc. right outside our windows. At the rear of the Fort is Edgcumbe Country Park - some 500 acres of parkland, with a herd of fallow deer and the National Camellia Collection - 600+ different species of these beautiful shrubs which flower in late Feb/March and herald the spring.
It is a magical place, but I am a townie, and we are about an hour's drive by car and ferry to Plymouth, the nearest city, where the hospital is.  My husband is 79 yrs young, and disabled, so the moving seascape is a blessing. We also own another apt in the Fort, which we let out for holidays and this not only keeps me busy, but we get to meet so many interesting people. This year we have had visitors from the USA, New Zealand and Germany. If you google Fort Picklecombe, you will see how unusual this place is.

Oh, the Midlands - this is where we lived before we retired to Spain in 1985, but came back for my health problems mainly Crohn's.  This is in the dead centre of England - we lived at Northampton. The weather in the south west is much warmer in the winter than anywhere else in England, but we do get some fantastic gale force 10 storms then.

Please let us know how you get on next Friday.

Liz.

[Rtist]

THANK GOD THANK GOD THANK GOD AND HALLALUAH....I am so happy for you.  Now just focus on being whole again.  I am so happy for you and wish you happiness and peace of mind and health.  What are the side effects of tamoxifin (tamoxifen) anyway??

[Rtist]

What you described sounds amazing.  I would love to see that area, perhaps vacation in your apt there?  I will look up the area on the internet and give you my impression.  I love big storms too.  I have to run out now....I will be on later to continue....Robin

[txgrl01]

The list of side effects is pretty long but I have only been experiencing two.  Joint pain and muscle spasms in my calves.  
I have never experienced joint pain prior to this med & my hips and knees are very uncomfortable.  I also get major "charlie horses" in my calves.  From what I hear it's not supposed to be a common side effect but almost everyone on tamoxifen that I've spoken to has leg pain and/or muscle cramps.
I speed walk about 4 miles a day so the knee pain is slowing my pace considerably.  I have started doing leg strengthening exercises at the gym but haven't noticed any improvement yet.
I keep telling myself that this is a small price compared to the cancer.
I am continuing to pray for you and your surgeon.  Check back and let us know how you are. ~Stacy

[Rtist]

Thank you.  I guess tamoxifen is putting a cramper on your walking.  Can you take an antiflammatory?  You must be in amazing shape.  I used to power walk that much too, kept nice and thin for catching a husband, lol, but now (remarried for 3 years), its time for me to get back into shape.  I do keep my weight down, so thats going in my favor for my health.  I guess its just one day at a time now.  You have a great weekend.  Robin

[Rtist]

[Rtist]

I looked up where you live and must say it looks absolutley amazing. What a wonderful place to retire and live.  I looked up also the surrounding towns and gardens.  This is what I've been looking for (my husband and I have been wanting to go to England for a long time now).  What is the closest airport?  How long would the car drive be.  I fell in love with Cawsand, Kingsand.  

[Rtist]

I didn't want to say anything while stacy you were waiting for your biopsy results, but I wanted to share a sad story about my cousin.  At age 38 she felt a lump in her breast and went to her gyno.  She was told to wait, that its nothing.  She went back a few months later, still concerned and he told her that women are cystic, it feels like a cyst and just wait because she had an annual mammogram scheduled in a few months.  A few months more passed and she then went to see another doctor (I believe her friends sent her to a breast surgeon) who told her he wanted it out immediately.  It was stage 4 and she went through chemo, surgery and died eventually not too long after.  She left 2 young daughters.  She was an intelligent woman (a lawyer), but naive when it came to questioning her doctor and going for a second opinion when he wanted to ignor it.  This is why when my first doctor told me to wait, after the radiologist insisted it was biopsied, I went for a second opinion.  With cancer, it is always better to be safe than sorry.

[lizziecee]

so very sorry to hear of your cousin's tragic story. Those of us with breast cancer always have the fear of recurrence at the back of our minds, but we do have to try and put it in a box and try as best we can to live normally. As my surgeon once said: "the only good lump is one in a jar". As far as I am aware the only conclusive test for bc is a biopsy.

Ah...the Fort. The nearest airport is Plymouth, but it is not an international one. Just flies within the UK and Channel Islands (Jersey ad Guernsey). Others are 2 hrs away at Bristol and Exeter. When I go to Florida each winter to stay with friends in Tampa, I fly Air SouthWest from Plymouth to Gatwick (near London) and then British Airways direct to Tampa Florida.  NorthWest flies to the UK (Heathrow or Gatwick) and there may be others. My husband and I are planning to go Omaha for 4 week next year to celebrate his 80th. Friends will drive from Omaha to Minneapolis, stay there a couple of nights, then onto the Badlands in the Dakotas and then Omaha for 2 weeks.  We can fly direct to  Minneapolis from Gatwick so it should be fairly easy for my husband who is disabled and can't walk more than 30 yds. Where are you in the US?

We can see Kingsand and Cawsand from both of our apts, and there is a lovely 20 minute walk along the cliffs on the  South West coastal path, just outside the Fort to these beautiful unspoiled villages. It is like stepping back in time - some good pubs and restaurants in the villages.

Let's see if my e-mail will get through as I am concerned we may be boring other people with health problems on this site. It is:
tedark at aol.com

Take care,
Liz.

[lizziecee]

P.S. the car journey from Plymouth airport, which is north of the city, is around 30-45 mins. depending on the time you hit either the Torpoint car ferry or by road across the Tamar bridge. We haven't learned yet to walk on water and we have to get over the Tamar river somehow. I often take a little foot ferry from Cremyll (about 6 mins drive from the Fort to the city or the hospital and have a cab waiting on the Plymouth side. The journey on the boat only takes 7 minutes, although it can be a bit rough and cold in the winter months. There is a book written on this part of Cornwall, entitled "The Forgotten Corner of Cornwall", by a local historian who lives in Cawsand which I could send you if we can ever communicate directly.There are a number of holiday apts to let here, by second home owners, if mine is booked. I can get details of their charges, once I know how many people will be staying. My holiday apt is a studio, sleeps 2, newly renovated kitchen abd bathroom and fully equipped. All apts have a view of Plymouth Sound and the water traffic.

Liz.

[Rtist]

I emailed you at ***@**** see if you got it.   Robin

[Rtist]

I emailed you at tedark at aol.com

[lizziecee]

Didn't get your email unfortunately -= perhaps you could try again at:
tedark at (ampersand) aol.com
Love, Liz.

[Rtist]

why don't you email me at Rtistluv(at)aol.com see what happens.  thanks

[Rtist]

[Rtist]

I got to mammograpy in my hospital gown and slippers and after the tests, they came in and told me that the microcalcifications only showed up on one photo, so they had to cancel the biopsy.  They explained it all, that if they can't locate, they can't biopsy and removed.  I have to now see if they can do a stereotactic biopsy, but they said I may have to wait a few months in case the same thing happened again.  It just left me relieved but confused.  I know better to be too safe.  I will keep you posted as to what's next.  They didn't want me to forget it and wait a year.  Have you ever heard of it just not showing up after 2 mammographies that showed a BIRAD 4?  Please give me your opinion.  Thank you also for all your help and encouragement.  You are so kind and special.  Robin

[txgrl01]

I am glad that there was nothing found but I am sorry to hear that you are still in limboland.  Stay on top of this.  Sometimes things just won't really show up on mammogram and u/s.  Have they discussed having an MRI biopsy?  They are really sensitive.  My calcifications only showed up on MRI.
My doctor recommended a follow-up MRI in 6 months to make sure that there is no change from the benign findings because of the the cluster of calcifications.  I felt pretty good about the benign finding until I got the "recommend follow-up MRI for monitoring"  I guess that's one of the hard things about being diagnosed before, overcoming fears of recurrence.
Again, I am so happy that they didn't find cancer.  Have a great weekend!

[Rtist]

Dear Stacy,
I will ask about the MRI biopsy.  I will get back to taking care of business tomorrow, meanwhile I will enjoy just feeling good.  Don't worry about your 6 month check.  They are on top of you and will work hard to make sure you don't get sick again.  My husband had his kidney out due to cancer and he stresses every few months from all the tests and scans they do..I guess its just part of who you are and don't borrow trouble if you don't have to.  If you feel good today, enjoy it.  There's so much time to worry when we have to, so make it always a great day.  I also am starting to feel like I am getting older (turning 50 this summer, who me?), my feet have pain on the bottoms of my heels and my neck is always out and my dentist said my gums are a little receeding.  Who me?  I always took pride in my healthy teeth.  So its new mouthwashes and new routines, new doctors and new tests.  I lived with lupus since I was 32 and then I thought "oh my god, how can this be happening to me?' and now its just who I am.  I will keep you posted on my diagnosing.  Don't worry!  For the next 6 months you can relax.  Your friend,  Robin