Calcifications

I would reinforce Dr. Moore's answer that not all breast findings need an MRI. There is no way that any of us can tell based on the information provided whether or not an MRI or other imaging will be helpful or necessary in this case - an understanding of the patient's clinical situation as well as review of the mammograms and any available pathology reports is necessary. In general, calcifications do not show up on MRI. There is no question that there are cancers that will show up on MRI that are missed by other imaging, but again each case needs to be properly evaluated before a blanket recommendation for MRI is made. There is no best imaging test for the breast, but that also does not mean that every test should be done in every person.

Calcifications in the breast occur commonly. The issue is whether there are suspicious calcifications in the opposite breast or not. Benign calcifications will tend to be scattered and rounded in appearance, whereas suspicious calcifications tend to be clustered, pleomorphic (different shapes), linear or branching (conforming to the inside of the duct).

The mammographic appearance is graded according to the BIRADS system, which goes from 0 to 6. BIRADS 1 and 2 and benign (no need to biopsy), BIRADS 3 probably benign (6 month follow-up or biopsy), BIRADS 4 and 5 suspicious (must biopsy), and BIRADS 6 (known cancer).

If there is a known cancer in one breast, any calcifications in the other breast will be regarded with heightened awareness, and may need additional workup. The incidence of synchronous bilateral breast cancer is in the range of 2-5%. Contralateral cancer may not appear in the same way as the cancer in the breast where the first cancer was found. It may be a mass on mammogram on the other side, or may only be detected on MRI, with no mammogram findings.

There is debate on whether MRI of the breasts should be done in cases of newly diagnosed breast cancer. In my own practice I usually order bilateral MRI to look for more than one cancer in the breast in which the first cancer was found, and to look for cancer in the other breast.