Yes, this creates a tricky situation. I would simply comment on my suspicion that there may be calcs and recommend a mammo be performed. Remember most breast calcs are perfectly benign. They can be old fibroadenomas, oil cysts, vascular calcifications etc. So seeing calcs on the ultrasound doesn’t mean much until they are assessed as suspicious for malignancy by mammo. The assessment of calcs should always be done mammo first, ultrasound second if possible.