Calcifications

What are calcifications?

Fact:  Most women have some calcifications on their mammogram.  We do not recommend a biopsy on all women with calcifications, because most women would therefore require multiple biopsies of both breasts.  Many calcifications are “watched” over time and only if they change, will a biopsy be recommended; ie if they increase in number or change in shape or begin to cluster.  Many calcifications will remain unchanged and will never require a biopsy. 

Why do calcifications form?

• Fibrocystic change (Does not require biopsy)
• Dermal calcifations – absolutely not a worry, these are located in the skin of the breast and the result of conditions such as a sebaceous cyst and have nothing to do with the breast tissue (Do not require biopsy)
  Calcifications in the walls of the arteries and veins of the breasts ( much like atherosclerosis of the heart arteries) (Do not require biopsy)
• Large “popcorn” calcifications can often be associated with the involution (shrinking) of a longstanding fibroadenoma ( a 100% benign (noncancerous) growth in the breast, similar to a “fibroid” (benign growth of the uterus). (Do not require biopsy)
• Dystrophic calcifications are associated with history of trauma to the breast (Do not require biopsy)
• Calcifications that appear to layer with gravity are consistent with sedimenting calcifications within cysts and are referred to as milk of calcium or microcystic adenosis (Do not require biopsy)
  

 

What is a stereotactic biopsy?

This is a minimally invasive approach, meaning small incisions, little trauma to the breast and quick recovery, that allows removal of the abnormal calcifications identified within the breast.  This breast tissue containing the calcifications in question is then sent to a pathologist who will analyze the tissue for abnormalities.  The patient lies prone (on your tummy with your face facing downward) with the breast placed through an opening in the table.  The radiologist / surgeon performing the biopsy works on the breast tissue that is suspended below the table.  The breast will be numbed with a local anesthetic ( small pinch and burning sensation as the medicine is placed in the breast).  The physician then makes a ¼ inch skin incision and inserts a device that allows for sampling of the tissue/calcifications.  The physician uses “x”, “y”, and “z” coordinates to find the area in question.  Approximately 5 – 10 samples are typically removed – each being the size of a small grub.   A picture of the samples as well as the breast is then obtained so that the physician performing the procedure is confident that the area in question has been adequately sampled.  A tiny (2-3mm) titanium “clip” is then placed in the breast for future reference.  This clip is placed in the unlikely event that the calcifications do reveal cancer, they will be gone and out of the breast and the surgeon who needs to do further surgery will not know what exact breast tissue to remove.  The clip is placed so that the surgeon will be able to  find that exact area in the future, if need be.  The small incision is then covered with a small piece of tape or bandaid; no suture is required.  The length of the procedure varies but typically lasts ½ hour to one hour.  You will be able to go home approximately 1 –2 hours after the procedure is completed.  You will be notified of your biopsy results within 5 days. There is typically no cosmetic deformity to the breast after the procedure. It is very common to have a fairly significant amount of bruising after the procedure.  

What is a wire-localized excisional biopsy?
This procedure is an “open” biopsy that is performed by a surgeon in the operating room.  The procedure requires not only a local anesthetic but also sedation and monitoring by an anesthesiologist.  Recall,  the calcifications cannot be palpated (felt) and cannot be identified with an ultrasound, in fact,  the only way to identify the calcifications is by the mammogram.  Therefore, in order for the surgeon to know which area of breast tissue to remove, the radiologist will place a wire in the breast under mammographic assistance adjacent to the calcifications.  The placement of the wire is done under local anesthetic (and is nearly painless) the morning of the surgery.  The patient will then meet the surgeon in the pre-op area and the x-rays will be reviewed by the surgeon.  The patient will then be taken back to the operating room and the anesthesiologist will sedate you.  You will be very comfortable throughout the procedure, with little to no discomfort.   An approximate 1 to 1 ½ inch skin incision will be made and the portion of the breast tissue including the wire and the calcifications will be removed.  Typically the “core” of tissue is the diameter of a quarter.  The length of tissue removed depends on the location of the abnormal calcifications.  The incision will be closed with sutures.  An x-ray is obtained while you are in the operating room to ensure the area in question has been adequately sampled.  The procedure usually takes 1 hour.  You will then be taken to the outpatient recovery room and likely be able to go home 2 hours after your procedure.  You will be notified of your biopsy results within 5 days.  There is typically no significant cosmetic deformity to the breast after the procedure. It is very common to have a fairly significant amount of bruising after the procedure. 

 

 Fact:  80 % of biopsies will be benign (noncancerous)

Of the 20% of you that will have abnormal results, most times the cancer that is associated with abnormal calcifications is  referred to as “pre-cancer” so as to distinguish from the more commonly known invasive breast cancer. 

Most calcifications, if abnormal, are associated with ductal carcinoma in situ (DCIS) which  is cancer of the breast, but by definition, it has not traveled outside the breast to other parts of the body and is therefore a 100% curable condition.  Keep in mind, all breast cancer, if identified early, is associated with a 98% rate of survival.