microcalcifications and milk of calcium

[misawa47]

I am 47 years old and a mammogram in July showed a cluster of microcalcifications with linear form. I live in a remote part of Japan so had to travel to the U.S. where I had a stereotactic biopsy done in Aug at a very reputable cancer center; however, they were unable to get any calcifications in the 12 samples. The doctor apologized and said the lidocaine washed away the calcifications. The final report stated that there was stromall fibrosis without evidence of microcalcifications. The same report was then amended 8 days later stating "although no microcalcifications were identified, the calcifications seen on mammogram may have represented milk of calcium which may have dispersed on biposy". It was later revealed by my doctor that the marker from that biopsy was not in the same place where the cluster of microcalcifications were noted.  I am now being sent to a different hospital in the U.S. later in November for another stereotactic biopsy.

My question is does the microcalcifications itself have to be sampled to determine if there is something, and can the lidocaine wash the microcalcifications away? They weren't able to numb me and the first biopsy doctor said she used the max amount of lidocaine.  My concern is that the next hospital may have the same trouble with numbing me and I will have gone through that horrible pain with no results. My Radiologist recommended a wire guided excisional biopsy; however, both hospitals used or plan to use the stereotactic biopsy.

Also, would the Radiologist who read my initial mammogram not know the difference between clustered microcalcifications and milk of calcium?

My anxiety level is really peaking as I am afraid of having the same pain as the first biopsy and possibly the same null results. It is very expensive for me to travel to these places and wait idly by for the results to come in. Please, any information would be most appreciated.

[japdip]

Since your Radiologist recommended the Excisional Bx you can certainly demand that one be done. Perhaps he could "order" it that way rather than just a recommendation ..... if that's possible under your circumstances. I cna't see why your Dr. or the Radiologist couldn't refer you to a Surgeon where you're going for the specific procedure and not leave it up to the institution. Have a written order and carry it with you. Do whatever you need to do to get the Exc. Bx ... jump up and down, have a fit, etc.    Good Luck ....

[misawa47]

The final report from the first biopsy did state that the microcalcifications "dispersed" during biopsy. When I returned to Misawa, the radiologist who performed the mammogram was very angry that they did not get the sample and that they called it "milk of calcium". My radiologist did another mammogram upon my return from that first biopsy and he said ALL the microcalcifications are still there and the marker was put in the wrong place. He said the biopsy was not done deep enough to get the microcals. My radiologist is the one that has me really scared saying it has all the attributes of cancer and this should have been biopsied in July or early August.

I actually found 2 bumpy hard lumps in my right breast (the microcalcifications are in the left breast). I have an appt with the surgeon on Wednesday to see if he can add the lumps from the right breast on the referral report for Hawaii. It may be cysts, but I want to make sure. I will also ask if they can PLEASE do an excisional biopsy so they don't miss anything. Can patients demand a certain type of biopsy when the doctor prefers another? I know their reasoning for the stereotactic is that it is less invasive; however, I thought if they were unsuccessful of obtaining microcalcifiation samples via stereotactic biopsy, the next step would definitley be excisional?

Thanks so much for responding.  I am very anxious to learn the results and I am praying every single day that it is benign.

[japdip]

I remember you from before. The lidocaine can (if injected too deeply) can obscure the microcalcifications on  biopsy. Yes, they do have to be sampled as that is the only tissue in the abscence of an actual lump that is avaiable at the suspicious site. Calcifications appear as tiny dots on film and milk calcium or milk in the ducts does not. They are what they are and there can be no mistake. It's only when they are grouped or clustered that they are cause for concern ... they do occur normally scattered about within the breast tissue. If I were you I would insist on a wire localization with exisional biopsy and have that understood before your next trip ..... you certainly have reason to demand this procedure since you have to travel such a distance.  Good Luck .....

[braveheart2]

I am so sorry to know how much anxiety you've had to go through, but happy to learn that you are on the verge of getting some answers! Because the microcalcifications are markers of increased cellular activity in the breast, I think it is important to get a biopsy sample that includes them to be sure the correct area is being sampled.

Do you still have microcalcifications visible on X-ray? If not, how will they perform a sterotactic or wire-guided biopsy without knowing where to go?

I don't know much about milk of calcium, but this seems to be a typically benign finding that should be apparent on the mammogram. From an article on benign breast microcalcifications on eMedicine (http://www.emedicine.com/radio/topic880.htm):
"Milk of calcium ... is a benign process that can be diagnosed readily during mammography, especially with magnification views in the CC and the true lateral (ML or LM) projections. When milk of calcium is imaged with a vertical x-ray beam on the CC view, the calcifications appear poorly defined and smudgy. When imaged with a horizontal x-ray beam on the ML or the LM view, the calcifications are seen as sharply defined, crescent-shaped, semilunar, curvilinear (concave up), or linear arrangements. The characteristic appearance of the calcifications on the magnification views helps to establish the correct diagnosis of milk of calcium."

I hope things go well for you -- we'll be sending you positive thoughts! Kind regards...

[nannotnancy]

FYI--I can't tolerate Lidocaine or epi., so I used Procaine or Marcaine for my procedures--at the dentist too.  It was at the dentist that I discovered this problem.  If you want an alternate drug, KEEP REMINDING THEM--they automatically use lidocaine it seems. Certainly they can numb you with something!

I don't know about microcal. washing away--but I do know that 8mm of DCIS was indentified on my biopsy, and MANY scans and 2 surgeries later, no sign of cancer has been found.  It must have been removed during the biopsy?  Kind of disturbing to me, but I guess I'll never know.  Anyway, I'm treating it as if it had been there, and did the surgeries and radiation.

Good luck to you!