Bi-rad 4: Surgical excision recommended for me

What does this mean: " None of the calcifications are amenable to stereotactic biopsy due to the extremely faint breast compression, as little as 6 mm"?

Is the surgical excision for biopsy purposes or for removal?

Bi-Rad 4 would seem to indicate a need for diagnosis as soon as you can get it. It's not Bi-Rad5 but still suggests some abnormality, as your report stated.

I hope the breast surgeon is reassuring and gives you good information and choices. Let us know!

I have been through this March of 2022. I would get a second opinion before I ever let another Dr. Do surgery on me. You need to get a second opinion because dense breast are very hard to read. You don’t know how experienced the dr reading your mammogram is. Mammograms are misread all the time. I wish I had taken the time to get a second opinion. I am a small breasted women. They took out 27 grams of my breast tissue. They found nothing. It’s like looking for a needle in a hay stack. Calcifications don’t always mean cancer. Don’t have anything done without a second opinion. Please don’t rush into this. I know the word cancer is frightening. You have the time to be sure. What they found was a congested area. This happens all the time. However the dr was so sure there was something there they took out so much tissue. My original spot was .5 cn ( pea size). No reason to take out 27 grams of my breast. That’s a whole cup size. Not trying to scare you but you have to take care of yourself. Take control and get another opinion. I found out later my radiologist was not a seasoned Dr.

‘Is the surgical excision for biopsy purposes or for removal’ —This is the part I’m not sure. The Radiologist said he can’t do the needle one for biopsy for me so he refer me to see a breast surgeon and he recommended I should have the calcification removed also for piece of mind. He made it sounds so easy.

Why can’t they do a core biopsy with a local with an ultra sound. That is a piece of cake to have. I would not let a surgeon do an excisional biopsy on me without a core being done first. Get a second opinion. I am so sorry you are going through this. I know how scary it is. But you have time to make a good decision. To get a second opinion they send your records to the place of your choice. It does not take a lot on your part. Do it before you let them do surgery. Not all radiologist are greated equal. Excisional biopsy is too invasive. I have had both.

Thank you @spinnerbait. I’m really scare about the surgical excision and I’d prefer not to do if not needed. I’ll ask for all available options when I see the breast surgeon this Friday.

The breast surgeon said needle biopsy can’t be done as I’m flat chested. What’s terrible is that she has to make 4 cuts (each cut is about 1inch, 2 on each breast, based on the mammogram ) to remove tissue out for biopsy. She also said I can wait 6 months for another mammogram and decide from there. She said she may be able to do one cut on one of the breast(based on the mammogram), so 3 cuts. I’m inclined to wait. I just think it’s horrible to do 3 cuts on a flat chested woman.

I am so sorry to hear you going through this. I agree with waiting six month and do another mammogram to see if anything changes. I think that would be my call as well. Can the do an MRI to get a closer look? I would think before they would do surgery they would want a better look. Keep in touch and try to stay positive as calcifications don’t mean cancer. It’s a possibility. I had 27 grams taken out because they thought they saw two lesions with calcification. No lesions and no cancer. I wish I insisted on an MRI. My surgeon was sure I had cancer. Keep the faith and read up the next few months. You will learn a lot that will help you make better decisions.

Thank you @spinnerbait. I’m 5 ft 7.5 and weight 103lb (that’s me all my life). I’m going eat up like I am pregnant next several months to prepare for the mammogram so in case if there’s still need to have follow up surgical excision in 6 months, I’m going in with a bigger and stronger body. I don’t know if that’s the right decision but I have been feeling everything normal except of this mammogram result.

I would advocate for breast MRI. I too have very dense breast tissue and strong family history. My Dec. MRI showed 2 suspicious areas, Birads 4. Next step, 2 core biopsies guided by MRI. I would like to add that my last 3D mammogram 7 mos. prior showed no new findings. Dense breast tissue requires additional screening methods!!! I was diagnosed with Stage1 ILC. This is a sneaky cancer and very difficult to find in imaging. I am currently healing from a lumpectomy and will have my treatment plan early Feb.

Wishing you the best of luck. Remember calcifications does not mean cancer! It’s a possibility! Let me know how you do! You’re not alone. This site is wonderful. I’m having anxiety also. Go for my first MRI since my Excisional biopsy. Not looking forward to it either.