what is the gold standard for microcalcification biopsy?

Abnormal mammo last Nov;(cluster of microcalcifications noted) repeat mammo in May with urging to get it biopsied. Had CAD assisted biopsy by radiologist within two weeks. Today had follow up with gyne who now wants a surgical opinion and "strongly" recommends an MRI of the questionable breast. He did mention that on a scale of 1-5, my microcalcifications were a "4". I'm confused - I had the biopsy is there something I'm not understanding here? I'm post total hysterectomy and have been on HRT since Dec 2007. Today's discussion with the gyne also focused on my unwillingness to give up HRT altogther to the point I had to sign a waiver before he would agree to even write for a refill. In theory he agrees with me that HRT should be indiviudalized and I'm normal weight, don't smoke, do excercise regularly, don't have habits such as smoking or drinking or eating anaimal fat/meat/etc. but he needs to cover himself as the literature flip flops over HRT constantly. What exactly has not been said in plain language?
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[japdip]

If you had a biopsy there must have been a pathology report on the area. The results of that report would be most important in the recommendation of any further treatment. This is something you mention nothing about in your post. If a surgical consult has been advised then I would assume that perhaps the area in question needs to be removed completely (wide excision) for some specific reason. MRI is often very helpful in aiding with the diagnosis. I'm very surprised with all the proven facts avaiable now that you insist on coninuing HRT. You are definitely increasing your risk of developing breast cancer if you continue this therapy. If it is prescribed at all since the studies were done it's for the shortest time necessary and in the lowest dose possible. The literature does NOT flip/flop over this ... the studies proved a few years ago that the increased risk is REAL. Your Dr. doesn't really need to cover himself .... he isn't the one at risk for developing breast cancer! If the BIRADS scor was 4 then the calcifications are suggestive of malignancy. A score of 5 would be a sure thing. If you aren't willing to follow thru with the recommended treatment (surgical) then I would say you are very foolish. You should be seeing a Breast Specialist anyway and I'm not saying anything against your GYN but this is not his speciality and you shouldn't expect him to treat you as if it were. If you have doubts regarding his recommendations (and they seem perfectly valid to me) then you should get a second opinion from either a Breast Specialist or Breast Surgeon. Regards ....