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Radiologists specialized in Women’s Imaging look for subtle tissue changes of the breast including small microcalcifications. There are many findings that a specialized radiologist in Women’s Imaging looks for on a screening or diagnostic mammogram to distinguish normal tissues from subtle changes of pre-cancer or cancer. These changes may be as obvious as a mass or as subtle as tiny white spots as small as grains of sand called microcalcifications. The term “microcalcifications” refers to the microscopic size of deposits that are actually composed of many kinds of minerals, not just calcium. If this finding is noted on a screening mammogram, then further characterization of the calcifications is usually needed with a special diagnostic mammogram called “magnification views”.
These special mammogram views are performed on the same mammogram machine that performs a screening mammogram. However, the regular plastic paddles and part of the mammogram machine are changed out to allow for a tall plastic stand to be situated called a “magnification stand”. The focal spot of the mammogram machine also changes. This combination of imaging the breast on a higher stand and changing parameters of the machine allows fine details in the breast (like calcifications) to be ‘magnified”. Although the mechanisms are different, think of the process similar to a “magnifying glass for the Breast”.
A specialized radiologist with many years of training in Women’s Imaging or Breast Imaging interprets the magnification images to distinguish the different patterns of calcifications and whether there are any associated findings. The more experience the radiologist has, the more confident we can be if a particular finding can be followed or if it needs to be biopsied. Some patterns of calcifications can be followed while others may require a needle biopsy to determine if they are benign or cancerous or in between (atypical). Calcifications are described and categorized by the American Cancer Society under a special lexicon called the Breast Imaging - Reporting and Data System, called BI-RADS for short.
The appearance of calcifications, the distribution, and any other associated findings may signal early changes in the breast tissue. We know that some patterns of calcifications are more suspicious than others. For example, diffusely scattered vague calcifications throughout the breasts are usually benign (noncancerous). However, other patterns such as irregular microcalcifications forming a small tight cluster or growing along a larger segment of the breast may suggest an early pathologic abnormality.
Since the calcifications may be so subtle that they need to be seen with magnification, they can not typically be felt. They are also not typically visible under breast ultrasound or Magnetic Resonance Imaging (MRI) because they do not have any measurable mass and don’t have any vascularity associated with them. Therefore, special means of performing a minimally invasive breast biopsy have been developed. Using magnified high-resolution imaging and triangulation techniques (yes, geometry), the calcifications are relocalized in three dimensions called “stereotactic” like sound in your car coming from different angles.
This procedure is usually scheduled for a different day than the diagnostic workup magnification to give you time and instructions to prepare. We ask that you do not take medicines that can thin the blood unless you are directed to continue taking them by your referring physician. Some patients may have special reasons they need to stay on their blood thinners such as a recent metal bore cardiac stent or clotting disorder. Always listen to your referring clinician regarding those decisions. We advise against taking aspirin if you are solely on it for prevention reasons. Do not use deodorant or body lotions or powders on the breast as this may produce false alarms as small aluminum or metallic particles may mimic calcifications. We ask that you refrain from any rigorous activities for one to two days after the procedure. So plan your tennis match either before or several days after your stereotactic breast biopsy. If you are planning an active vacation to include swimming, rigorous hiking, skiing, you may want to postpone the biopsy until you return. Even though there will be only a tiny nick on the skin, we want to minimize the chance of soreness, infection, or bleeding at the site.
On the day of the procedure, you will lie on your abdomen on a special x-ray protected padded table (which looks like a massage table). Like all of our procedures, you will see several assistants to help with the procedure- the Technologist, the Radiologist, and a Patient Navigator. The technologist will obtain a few low-dose mammography magnification views for targeting. The radiologist will anesthetize the skin with a tiny numbing needle and use Stereotactic Guidance to see exactly where the calcifications are located in 3D space. Another special needle called a “probe” is then inserted at the target site, more anesthetic is given through that probe, and a light vacuum is directed to the calcifications. A sample obtained is x-rayed and is picked up by the Pathologist.
You will likely experience slight bruising of the breast for a few days. Some women may complain of feeling a lump under the biopsy site for up to a week. When we take a tissue sample containing the calcifications out of the breast at a particular site, the body sends scrum and blood to that area naturally. This lump is the body’s way of healing that area. If the lump is the size of a small plum or larger, we ask you to call our clinical Care Team at The Women’s Imaging Center and select the physician/ patient pathology option to discuss any changes to your protocol. Infection is extremely rare, but if you have any redness at the site (that does not follow the line of the tape), any fevers or chills, we ask that you call us or return to The Women’s Imaging Center for evaluation. Direct contact sensitivity from the tape on the skin can be common in some people and often is associated with a geographic non-warm, non-streaking area that fits the line of the tape perfectly. So if the tape is itchy or burning, remove it and wear a tight sports bra instead. Call us or your referring clinician if you have any concerns at any time.
Results are available in 1-2 working days after the stereotactic biopsy. Note that if the stereotactic breast biopsy is performed on a Thursday or a Friday, for example, then results will be available on Monday or Tuesday respectively. The Women’s Imaging Center Patient Navigator and the Radiologist correlate the results and coordinate any follow-up care or management indicated. Follow-up magnification images after biopsy may be recommended even for benign biopsies. If the biopsy proves to be cancer, then contrast Breast MRI will be recommended at The Women’s Imaging Center to help with treatment planning. We will work with your referring clinician to coordinate an individualized treatment plan with surgeons or oncologists to fit your particular needs.
The Women’s Imaging Center is proud to announce that we have added 3D Tomosynthesis Mammography at our Denver/Cherry Creek location. Our other locations in Lakewood, Littleton and Westminster/Arvada all use the highest rated digital mammography systems, Hologic Dimensions and Selenia. Our main scheduling number remains 303-321-CARE (2273) for all our locations. The Women’s Imaging Center is committed to providing individualized, innovative, state-of-the-art healthcare to women.