stereotactic core biopsy

[medwriter123]

Recent mammography screening and follow-up showed a cluster of heterogeneous microcalcifications in the anterior right breast at the 12 o'clock position. The breast tissue was depicted as "heterogeneously dense." Final impression was: ACR BI-RADS 4B (intermediate suspicion for malignancy).

Brief medical history: age 58 years, white, nonsmoker, nondrinker, very low bone density, celiac disease (diagnosed 2003), thin (between 95 and 100 pounds, but weight has been stable throughout adulthood), height 5'3". Hysterectomy (1991) benign breast lump (1990), two broken metatarsal bones (2007). Only current medication: 0.025-mg estradiol patch.

Questions: Is stereotactic core biopsy a logical first step? What are the key biopsy parameters (number of samples, etc.) and procedural risks? How definitive are stereotactic core biopsy findings? Should the procedure be performed at a large breast center, or is it sufficiently routine that it could be performed locally?

Thank you in advance.

[Cleveland Clinic]

Dear medwriter123:  Microcalcifications are small calcium deposits found within the breast tissue and these are normal. Microcalcifications in and of themselves are not a condition that would become cancerous.  However they can be a sign of a problem that may need further investigation based on their appearance on a mammogram.  For instance microcalcifications that are more scattered are probably due to a benign (non-cancerous) cause and microcalcificatins that form a cluster may increase concern that there may be an underlying tumor.  Microcalcifications that are indeterminate may need further investigation such as a diagnostic mammogram to further characterize the calcifications.  Calcifications do not move around but more may form over time.  The pattern of their formation lends clues as to whether or not more investigation is needed.

A stereotactic biopsy uses imaging (mammography for example) to visualize the calcifications and get samples (number to be determined by the doctor) for examination under the microscope.  It is a fairly low risk procedure in that the usual risks are discomfort and sometimes bruising.  Core biopsies are done based on the assumption that the results of the samples can be generalized to the entire area of concern.  If there is anything concerning or unclear about the biopsy results, an excisional biopsy could be recommended.  Stereotactic biopsies are fairly common but you may want to ask questions about experience and what pathology lab is used (how long will it take to get results) from anyone you would be considering to do the procedure.  Ultimately, your comfort should dictate where the procedure would be done.  

[medwriter123]

Thanks so much for your very helpful response.