Grouped calcifications are present in the upper outer left breast. This was called BI-RADS 0, and the patient was recalled for spot compression magnification views.
These calcifications are pleomorphic and in a linear distribution, and are considered BI-RADS 4, Suspicious.
A stereotactic biopsy was performed.
The core samples and post-biopsy mammogram are shown:
The pathologist reports benign calcifications is association with arterial wall. What is your assessment?
Recommend return to annual screening mammography Recommend follow-up mammogram in 6 months Recommend repeat biopsy due to discordant results
This result is discordant
The calcifications that were targeted were not vascular calcifications, but were adjacent to a calcified vessel. Look back at the post-biopsy films to see that indeed that vessel was interrupted and there was a small hematoma. The core samples look vascular as well. Thus, a repeat biopsy should have been performed.
Alas, this patient was recommended to have a follow-up in 6 months. Here is that study
Now what is your recommendation?
Return to annual screening Repeat core biopsy Surgical excision MRI
The pleomorphic calcifications have increased in number, and are now associated with a surrounding density
This is very suspicious for DCIS now. A repeat stereotactic core biopsy or surgical excision are both reasonable. An MRI is not really neccessary at this time. This patient elected to have a surgical excision which yielded DCIS.
