Skip stereo bx for straight to excision for susp microcalcs?

Tucker88

Hi all,

This is my first post, so I apologize in advance if it's in the wrong place. I'm hoping someone here can offer some guidance.

My background:

In 2010 I had a stereotactic core biopsy after a small group of microcalcs were found during mammogram. I was 42. Pathology came back ADH. Wide excisional bx (ie, lumpectomy, altho I didn't know it at the time and no one called it that) revealed no further abnormalities. I was lucky in that the stereotactic procedure removed all the tissue of concern. I was followed 2x/yr for the first 2 years and then placed back on an annual screening schedule.

After 8 years with no issues, I had put ADH in my rearview mirror until this Jan. when my annual mammo followed by diagnostic pictures again revealed a small area of microcalcs, same breast, completely different location. Radiologist rec bx. In conjunction with a top breast surgeon/researcher, I adopted the "active surveillance" approach and we agreed that since this group looked "just like" the area in 2008, I would return in Aug. and rescreen the area.

As Aug. approaches, my anxiety level is rising because I know I will be pressured to have a bx. I don't expect the area to have magically disappeared, so I can't live in denial indefinitely.

My question is: is there an argument to be made for going straight to an excisional and skipping the stereotactic altogether? I would really like to propose this and want to come to the appt. prepared with valid reasons for discussion rather than simply an avoidant reaction.

I was not a good candidate for stereotactic. The sound caused me to jump 2x, resulting in having to re-do it. The needle hit a vein, causing a significant hematoma. My breast didn't stop bleeding heavily for 2 hours--I was given towels and put in a room, alone, to wait until I stopped bleeding enough to go home. I was given something to relax prior to the procedure (xanax or valium, don't remember)--little to no effect.

Since this area has been evaluated to look so similar, I can't think of any reason why another excisional would not be the next step, so why not just go directly to that and save me the agony of the (barbaric, imo) stereotactic, stress of waiting for two bx results instead of one, added costs, time off work, etc. etc.

Thoughts? Has anyone been successful in this approach?

Thanks for any and all who read--I know it's long.

Lula73

Depending on how the microcalcs are clustered, they can be pre-cancerous and need removal. They can also signal cancer is present. Or they’re just there and harmless. Mammos and u/s don't always pick cancer up. (For me, mamm picked up microcalcs in left breast, set up for lumpectomy of them but radiologist said mri first...BC found in opposite breast that mammo didn't pick up at all). I would ask for breast mri before anymore biopsies to get a better look at things first then go from there. Just my $0.02