Do I get a biopsy or see a surgeon?

[Sniglet]

I recently had my mammogram report back and I an area that they want to look at.  My doctor said I could either have a biopsy by a radiologist or see a surgeon.  The report says..

Suspicious abnorality in right breast (BiRads Category 4)
Suspious area of ill-defined microcalcifications within the inferior/central/posterior aspect of the right breast.  No archetectural destortion is evident.  They called them vascular calcifications.  

I saw the x-ray and it looks like a dotted line of calcifications.

Any help in making this decision is greatly appreciated.

[CCF-RN,MSN-rf]

Dear Sniglet:  It sounds like they are offering either stereotactic biopsy or excisional biopsy, either of which would use radiology to locate the area of concern.  The first thing to do would be to determine whether these calcifications are, in fact, suspicious.  A review of the mammogram will help with this.  However, if a biopsy is determined to be necessary, a stereotactic biopsy is use of mammography and a large bore needle is placed into the calcifications (x-ray taken to confirm proper placement) and samples of tissue are taken and sent to pathology.  An excisional biopsy is using mammography to place a wire into the area of concern.  The surgeon then makes a small incision and removes the tissue around the wire and sends it to pathology.  Depending on the mammogram and personal preference, either method can be acceptable.  A breast specialist may be able to help sort out the issues.

[surgeon]

Some surgeons prefer to have such things handled by the radiologist before they even see the patient. My personal approach is to want to see the xrays and the patient first, because many times a biopsy can be avoided. Without seeing the pictures, it's impossible to give you a meaningful comment. But usually vascular calcifications (meaning deposits in blood vessels, which have nothing at all to do with cancer) are pretty easily distinguished from calcifications due to cancer.