Stereotactic Core Biopsy scheduled

MomMN

I have a stereotactic biopsy scheduled for next week and I am thinking of rescheduling and doing it after the holidays. I don't want to get bad news a few days before Christmas!

I went for a mammo 6 months ago after finding a lump, that lump turned out to be a cyst, but then they found suspicious microcalcifications in the other breast. Actually they found microcalcifications scattered throughout both breasts but there is one area at 12 o'clock on the left breast where they are clustered or have a pattern. I think he said 5 of them? From what I can remember of the report it said suspicious abnormality and clustered mildly indeterminate microcalcifications, birads 4. Anyways the radiologist said 80% benign and that he recommended a biopsy but that I could also come back in 6 months for a follow up mammo. I have an extremely high deductible and insurance won't cover the biopsy, so I decided to wait and do a follow up mammo. However when I called for that, I had a call back from my Dr. saying that another radiologist had looked at my films and said I needed to come in for a biopsy, that just doing another mammo wouldn't do any good. So now I am terrified! I am 42 and have no immediate family history of breast cancer, however there is a high incidence of prostate cancer in my family. I do have a history of lumpy breasts. I had a fibro lump removed from my right breast when I was 19 and then the huge cyst that I had 6 months ago.

I waited 6 months, another week won't make a difference I suppose. Or should I just go and get it over with? i don't know what to do.

I am scared of the procedure also as I have small breasts. Can they do a stereotactic easily on small breasts?

Thanks!

YoungTurkNYC

Do not be scared of the biopsy. It is one of the easier procedures. You might have some bruising and discomfort afterwards but very manageable. In my opinion, it is best to know something (good or bad news) as soon as possible.

MomMN

I am very worried about the biopsy. I've been doing some googling and I don't even know if my breast is big enough to hang below the table far enough like in pictures I've seen! I also worry as I read on these boards of a woman who had a botched stereotactic biopsy and the needle went all the way through her breast! As my breast is small, how likely is that to happen? Then one of the risks listed is the needle puncturing a lung and collapsing it. Which would seem to be more likely with a small breast, right? Is the needle set at a preset depth or is the radiologist able to control it? Is it just pulled like a trigger or controlled with precision by the radiologist?

If they have to take multiple samples, won't that cause my breast to look deformed as it is small to start with?

Also, does having this done actually create more calcifications in the future? So next mammo they could see more and want another biopsy? and so on.

I am actually tempted to just do another mammo and if nothing has changed then I wouldn't even need a biopsy, would I?

MomMN

Another reason for waiting until after the holidays is I still having a lot of baking and shopping to do. WIll I be able to roll and cut cookies and shop and wrap after the biopsy? It seems a lot of people get hematomas after the biopsy.

The fact that I have already waited 6 months worries me too, I worry that it will be cancer and has already spread. ugh, I am just freaking myself out here, sorry

MelissaDallas

Waiting until after the holidays would be fine and won't make any difference. If your deductible starts over at the first of the year it might be better, because sometimes if they find atypical cells on a stereotactic biopsy they will want to do an excisional biopsy.

Very few women, even with small breasts, have any trouble with the stereotactic biopsy. Almost everyone comes back here & says it wasn't nearly as bad as they feared & they had very little pain. I think you focused on the few bad things you saw and not the hundreds that said it was fine. The vast majority have no complications, including hematoma. You will be bruised some though.

Even having waited, your odds are still better than 80% that this will be benign.

I know it is really anxiety producing. We've all been there.

Ariom

Whoa there MomMN! Try not to get too far ahead of yourself here.

One of the best pieces of advice given here, is to stay away from Google. There is so much irrelevant information there that will scare you.

I know all this stuff is very daunting, but as YoungTurkNY says, the biopsy is really nothing to be afraid of. It is generally very well tolerated, and the negatives that you mostly hear about is to do with holding the position for a long time. There are women here of every conceivable breast size who have undergone this procedure with no problems.

I doubt you'd have the slightest problem doing your cooking and baking. You may have a little bruising, but the little frozen packet in your bra will relieve that. You may hear of a hematoma forming occasionally, but it isn't the norm, and I haven't ever heard of a punctured lung from a biopsy.

The procedure is done by a trained professional, with a precision instrument which takes small cores of tissue to be tested in pathology. I haven't ever heard of a breast being compromised by losing that tissue, but I have heard of most, or all of the microcalcifications being removed during the test.

If it were me, I would go with the recommendation of the Doctor. He is being pro active, with your best interests at heart. Everyone pretty well has microcalcs, but it is when they present in a pattern that DCIS can be present. Another week won't make any difference in the grand scheme of things, but I think just waiting and having another Mammo is a waste of time and money which will probably still indicate a biopsy anyway.

The figures show that the odds are in your favor for a B9 result, but in the remote chance that you have anything more, wouldn't you rather know and act on it?

We all understand that you're nervous, we have all been there too.

I wish you all the very best, and hope for a B9 result for you!

cactus

MomMN, I was worried about a lot of the same things, before I had mine in September. Some stereotactic biopsy tables have one big hole instead of two holes for your breasts to hang down. I have small breasts too, and they had me put one arm and one shoulder through the large hole. It was definitely an odd position, but it was doable, and it let them get a good view of my microcalcifications that way. The mammographer who has done my mammograms for years helped my surgeon with the biopsy, and I questioned her before hand. I said to her, "you've seen how small my breasts are, are you sure this will work?" She assured me it would be fine, and she was right.

My area was close to the chest wall, and my surgeon was able to locate the spot very precisely. He did take multiple samples, and as Ariom mentioned, in my case these samples managed to remove all of the microcalcifications.

I wondered if my small breast might have a changed shape too, so I understand your worry, but it did not. About ten days after the procedure I did notice a small dimple in the tissue, on the very bottom of my breast, only if I raised my arm straight up. Within about a month, that went away entirely, and my breast looked the same as before. No problem at all.

I think it varies, but I didn't even have a single bruise, and no hematoma. The only limitation my surgeon placed on my activity was not to lift heavy items for a few weeks.

The biopsy and pathology report gives us an entirely different level of information than the information we get from a mammogram; it's the only way we can find out for sure about something that looks suspicious in an image. We're all different, but I always have a big sense of relief when I get some solid information. I think part of what is driving you crazy (I've been there a lot in recent months!) is the not knowing, and the best way to end the not knowing is to follow your doctor's recommendation and do the biopsy.

We're all hoping for benign results for you. Try to focus on the fact that the odds truly are in your favor, and hang in there. This is a wonderful forum full of people who will help you any way they can, so you don't need to feel alone.

MomMN

Hi! I have a few quick questions-

Do they always implant a titanium chip when they do this procedure? I do not really want that done. With small breasts I don't see how it would be hard to find what they were looking for if they ever need to in the future as there is not much area involved And I have read that some women are getting reactions to them and wish they had never had them implanted. I guess that is only from women who had benign results though.

Also, I am wondering, what if I just go ahead and do another mammo 1st? What if nothing has changed since my last mammo 6 months ago? Would I still need a biopsy? I am going to call tomorrow and ask my Dr. these questions also.

And can these biopsys and all these mammos cause cancer? I read an article once that said that cancer often grows at the site of a previous injury.

Thanks for all the replys and help! I am going to try to turn my brain off now and get some rest

MelissaDallas

Mommn,

You seem to be fixating on all the most far-out possibilities of things to happen.

Yes, you need the marker & you will never know it is there. Allergies to titanium are exceptionally rare. They need to be able to refind an area in millimeters and if your biopsy is benign it will be used to mark previously biopsied spot on your future mammograms so they recognize that there could be scar tissue & not a new place that needs another biopsy.

Another mammogram will still show clustered calcs that need a biopsy.

Biopsies certainly don't cause cancer and the amount of radiation in a mammogram is very tiny and not cause for concern. I have seen no research that says cancer grows at injury sites. It grows because genes mutate.

MomMN

I am going ahead with the biopsy next week as I am driving myself crazy with worry (as you've clearly seen- thanks for listening and the help!

I may ask them to wait until after Christmas to give me the results however.

What has me worried now is that I have scattered microcalcifications in both breasts. And the one small area 12 o'clock left, where there is a tighter group of 5. Does having calcifications everywhere make it more likely to be positive for something? I am worried that having so many microcalcs is bad.

Also, does the area of the microcalcs tell anything?

Thanks again!

MelissaDallas

Most of us develop calcifications as we age. Scattered ones are pretty "normal" . It is when they present in clusters or groups or linear fashion that they may be an indication of cancer developing. Most frequently that turns out to not be the case though.

You'll get through this just fine. The biopsies really aren't bad. The worst part of the whole thing for me was lying on my stomach on the uncomfortable table. The biopsy itself didn't hurt. Just a little sting when they started numbing me. Drove myself home. Might have taken an Aleve that night, but really, usually they are not a big deal for the vast majority of women.

AnxietyAnne

MomMN I have my biopsy tomorrow. I will be put to sleep, they say I have to because of the location of the microcalcifications. My follow up is December 24. I have made up my mind to ask that I not get results until after holidays. I just don't want to take the chance of spoiling the holiday with bad news. I know that I will still worry but I have been handling the worry pretty well so far. All the best to you and I hope for benign results for both of us.

Bren-2007

Anxiety Anne ... good luck on your biopsy tomorrow. Having twilight to do the procedure will make it very tolerable.

MomMN ... wishing you all the best as well. I've had two stereotactic biopsies. I was really scared too. As Melissa stated, the table I was on for the first one was very uncomfortable. The second one I had in a seated position with a really good radiologist who made sure I was sufficiently numbed up prior to the procedure.

I didn't have too much pain afterward, but did have a bit of bruising. I had my results two days later.

Sending hugs to you gals

Bren

ziggypop

MomMN - I had an MRI guided biopsy (which is much like a stereotactic biopsy). The procedure isn't fun - kind of like having a cavity filled isn't fun. I did have a hematoma from mine which is VERY rare - happens maybe one in 10,000 times. But were I going in for the same procedure tomorrow, I would not worry about the procedure itself at all. People don't tell you about all the times that they have these with nothing at all going wrong - so you only hear about the (very infrequent) times that something does go wrong. The little titanium 'seeds' are nothing I have many of them in me can't feel them don't notice them. Think about all the people walking around with 'things' in them - hip replacements, knee replacements, pacemakers, etc.

MomMN

AnxietyAnne-

Good luck tomorrow! I hope things go well for you!

naturegirl11

I'm a nervous wreck myself waiting to find out what is going on with me and not knowing if I can handle the holidays, Before or after has been my question. Whatever feels right to you is what's right! I'm saying a prayer for you tonight for you health and well being. May you get through the procedure with ease.

MomMN

I may have to call and make the appointment for after the holidays, it turns out. The brake warning light went on in our car and we had an appointment to take it to the mechanic today but he got put in the hospital. And the day of my appointmant looks like snow here. The breast center is quite a drive. Do I want to make that drive in the snow with a brake warning light on? They seem to work fine, but who knows. ugh. I want to get it over with but don't need more stress added to the day. I am worried that it has already been 6 months since the first mammo. I don't know what to do. I sort of just feel like throwing my hands up, getting in the car with iffy brakes in a snow storm to have a biopsy and letting it all be up to the fates.

MomMN

Well I rescheduled for December 27th. I figure it's only a week difference and this way I don't have to worry about the brakes and snow on top of everything else and can enjoy my wrapping and baking pain free.

Happy holidays and best wishes to everyone!

cactus

Best wishes to you too, MomMN. Enjoy your holidays, and keep us posted on how you're doing.

ggo85

I was basically in your shoes 18 months ago. The radiologist told me that he was "pretty sure" my microcalcifications were benign but if he were me (!), he'd have the biopsy "just to be sure". This was after 9 yrs of perfectly normal mammograms, so I was totally freaked out.

Must say the procedure itself wasn't all that bad. I stayed home after but could have gone to work physically. Mentally, I was a wreck. I got the call 2 days later -- on my BD no less! When the radiologist said it was B9, I literally cried. Don't worry about the titanium chip -- you will NEVER even think about it and it will save you having unnecessary tests later on.

I had to return in 6 months for another diagnostic mammo to confirm that calcifications in my other breast hadn't changed. When the MD said that "everything was fine" and I could go back to a yearly mammo schedule . . . it was the best.

Bottom line is that most folks do get good news. It's normal to be somewhat freaked out. But the odds truly are with you. Be strong and try your best to enjoy the holidays.

MomMN

Well my biopsy is tomorrow. Yuck.

I have a question, I tried calling the biopsy nurse at the breast center where I am having the biopsy but just got messages. Anyways, my daughter has been sick with a cold and today I am feeling a little congested & I also suffer from allergies. I wonder if it is ok to take sinus & allergy medication before the biopsy? I know I cannot take aspirin but they said nothing about this.

Feeling very nervous and I'm sure I won't sleep at all tonight. I am looking forward to being done with this although very worried about results.

MelissaDallas

the only contraindications I've ever gotten are aspirin or any of the nsaids as they can make you bleed. Your cold medicine shouldn't have aspirin, motrin or aleve in it if you take it.

MomMN

Well I just got back from my biopsy. For all of you that read this that are worried about having a stereotactic biopsy done- don't be! It was virtually painless! (I don't know how the after pain will be as I don't think the lidocaine has worn off yet) The biopsy part only took a few seconds and like I said I felt no pain at all. The worst part was the worry. If I had known how easy it was actully going to be, I wouldn't have been worried at all. The procedure itself was so much easier than I expected! I am so glad it is over with. Now I just have to worry and wait for results.

marie5890

MomMN, glad it went well.

Lets us  know when you get your results…

Good Luck

emwills

SO happy to see it wasn't as bad as your thought! I go in on the 9th for mine! Praying for good results for you! 

MomMN

The results should come today or tomorrow and I am having a bit of anxiety. What I had thought were just 5 clustered microcalcifications were in fact so many that they didn't even count them. I am scared as there were so many. And that they are in the other breast too.

When the radiologist walked in he asked if I had ever been in a car accident, which I have, just over a year ago, and this breast was bruised, so I told him that. But it was not bruised in the area of the calcifications. I was too nervous to explain that part. He seemed to think that this was from the car accident, but it can't have been if I was only bruised on the side (It also doesn't explain all the microcalcifications in the other breast that he said we have to keep an eye on) I wish I had explained that. He did also say that it was going to be more difficult to pinpoint a location to biopsy as they are "in more of a whole region". Is that good or bad? I have read that having a region of them means benign and then I have also read that the more microcalcifications, the more chance of malignancy.

I am scared. I had not seen my mammo before and seeing all those microcalcifications was scary. I don't know why the first radiologist ever told me that there were a few clustered together, when in fact it is a whole region of them, actually they are everywhere in both breasts but there are tons in this one area. I'm scared because if this is something bad, it is big.

marie5890

Mom,

Slow deep breath.

It could very well be that the microcals are a result of internal bruising from the accident.

It's when they present themselves in certain patterns that the are more concerning..(i.e. "clustered" or "linear")…

Microcals are very common, for a variety of reasons. So hold on. Let us know when you hear...

ziggypop

Mommn - slow down a bit and breathe. LOL (I just saw marie's post). Remember how scared you were of the biopsy? Scroll back up to see. And then it went fine. Now you are getting really scared of these things that you haven't seen before & saying what if? What if ?

It may be that one or the other of your 'what if's' turn out to be true. Maybe that's cancer in there. Let's say it is. What will happen? What will happen is that you aqnd your docs will come up with a treatment plan and it will be a pain in the a**. Worse than the dentist, worse than the dentist plus sitting through sixteen excruciating arguments with your SO in which you lose everyone. But the big thing is, it is really, really, really, unlikely to kill you. So you will be okay. 

If it's cancer, we will be here with you every step of the way. If not, YAY! go live your life, but either way you will still be living your life, it will just be different. 

MomMN

Thank you all for your posts and help! I had just a bit of a panic attack earlier It's been a stressful 6+ months not knowing what is going on. It has helped so much to have this board and others to vent with.

This last radiologist (the one who did the biopsy) didn't seem overly concerned so I will focus on that. The radiologist before him though really scared me when he said I should not do the 6 month mammo follow up and to get in asap for a biopsy. Hearing that after 6 months of already waiting really scared me. It's a stressful thing. And reading and researching these last 6 months has made me really aware of breast cancer, I knew it was common but I am shocked at the epidemic of it. It's scary. My daughter is on birth control and I worry about that now because of all I've read.

Also, how accurate are sterotactic biopsy's? Do they often miss cancer? As he said it would be hard to biopsy because they were in such a big region that he didn't know where to pinpoint the biopsy. He said they may have to do it a couple of times and go back for more samples, but then only ended up doing it one time.

Again, thank you all for your help and support, it has helped so much!

Beesie

Stereotactic biopsies are ~95% accurate.  But there are procedures that are used to address situations where the results may not be accurate. 

First, accuracy increases based on the number of samples taken.  If the result is benign but the radiologist is concerned that too few viable samples have been captured, then normally an excisional (surgical) biopsy will be recommended.  When I was having my stereotactic biopsy, I had two different areas of calcifications and I knew from the radiologist as the procedure was happening that I might have to go back for an excisional biopsy because the radiologist was concerned about the quality/accuracy of the samples from one of the calc locations. 

Second, in cases where the results of the biopsy are discordant with the imaging, an excisional biopsy will be recommended.  This could be a situation where the imaging is highly suspicious but the stereotactic biopsy result is benign, or it could be a situation where the biopsy results don't show anything, either benign or malignant, that explains the imaging (for example if the biopsy sample is simply normal breast tissue with no fibrocystic conditions or any abnormalities).

Third, if a high risk condition such as ADH or ALH or LCIS are discovered through a stereotactic biopsy, then normally an excisional biopsy will be recommended.  This is because breast cancer tends to develop from these conditions, so where there is one of these high risk conditions, there is a greater risk that some cancer might also be present.  Therefore in these cases, the entire suspicious area is removed surgically to ensure that nothing more than the high risk condition is present. 

These procedures usually lead to the discovery of any cancer that might have been missed by the stereotactic biopsy.  And as a fourth precaution, normally a 6 month follow-up is scheduled after a benign biopsy.  This monitoring is done just to ensure that the area that tested to be benign doesn't change and appear more suspicious. It's really pretty rare that a benign biopsy results in a breast cancer diagnosis that is not discovered for 6 months or more.

MomMN

Got the results- B9!!!

I am so relieved! I started to have some hope with the radiologist who did the biopsy as he didn't seem concerned. It seemed like if he had been the one to first see my mammo, he wouldn't even have recommended biopsy, but who knows for sure. I don't know what he is recommending as far as further mammo's or what, they are suppose to mail me the info and results. All I heard was "completely benign breast tissue". I thought for sure it would at least come back fibrosystic or something with amount of calcs that I have. Or maybe that falls under "completely benign breast tissue"? I almost wish I had just done the 6 month mammo now but I suppose I would have always been worried not knowing for sure.

Thank you again for all the help, it has been greatly appreciated!