DCIS: stereotactic biopsy vs excisional biopsy

I was diagnosed with a stage 1 invasive ductal cancer 2.5 years ago at the age of 50.  I received a lumpectomy, radiation, tamoxifen and Lupron (because Tamoxifen stimulated my estrogen).   I was premenopausal and cancer was >95% Er+ and Pr+.  I tested negative for BRCA1&2 genes despite a strong paternal family history.  My most recent mammogram (including magnified views)show suspicious calcifications in BOTH breasts!  The radiologist said that a stereotactic needle biopsy or excisional biopsy could be done but they favor the excisional biopsy.  Here are my thoughts and I'd like your comments back:
If they don't think that it is likely to be DCIS then it would be better to do the excisional biopsies to make sure they hit the right spot. If they think it probably IS DCIS, then wouldn't it be better to avoid having 2 surgeries?  I'm assuming a mastectomy would be dictated since I"ve already had radiation in one breast.  Or is there too much risk with the stereotactic biopsy of missing it?  Comments, please!

[CCF-RN,MSN-rf]

Dear ritavv:  In theory, either type of biopsy could be appropriate.  However, given your history, my speculation is that your doctors would feel more confident about the end result if all tissue in question was removed rather than a small sample.  Taking a small sample can possibly leave a problem behind.  Having said this, neither technique is wrong.  What I think they are trying to avoid is having a stereotactic biopsy come back negative and feel that an excisional biopsy should have been done.

[surgeon]

it depends somewhat on the nature of the calcifications: tightly clustered, vs more spread out. I'd suggest asking the radiologist exactly why the recommendation was made, and see if it makes sense to you. It's true that with stereotactic biopsy, sometimes one gets an equivocal result such as "atypia" (meaning abnormal but not definitely cancer) in which case excision is usually needed to be sure. It's usually possible to confirm the presense of calcifications in the core of tissue that's removed, but if the calcifications are diffuse and variable, then the question arises whether adequate sampling has been done.

[ritavv]

Thank you for your quick response.  The radiologist did show me the calcifications.  One looked like a clump at the site of my original lumpectomy.  (By the way, in my original surgery I had 1cm clean margins and no DCIS seen)  The calcifications in the other breast he said previously looked like powdery calcificatins but now in several small spots it looked like the calcifications had increased along the duct.

One last question... since I'm on Tamoxifen and Lupron, does this suggest that if it is cancer, it is most likely ER-?

[bealady]

I have heard that stereotactic biopsys are very painful.  Is this true?  I am scheduled for one next week and don't know what to expect.

[ps131]

Dear Bealady - I had a stereotactic biopsy a couple of weeks ago and is wasn't what I would call painful.  Here is what takes place: You lay on your stomach on a table. The table has a hole in it and your breast hangs through the hole. Your breast is then compressed, similar to a mammogram, but not painful. They then give you a shot of lidocaine. This is the only thing that is a little painful.  You will feel the pinprick of the shot and then a kind burning sensation when they put it lidocaine. Nothing extremely painful just somewhat uncomfortable and this just lasts a couple seconds. They will then do the the biopsy and you shouldn't feel a thing. If you do, tell them and they will numb it more. During this time they will keep taking xrays to make sure they are in the right place. They will also insert a tiny metal clip (looks kind of like a tiny staple bent in half) so they will be able to tell in the future where they were. After they get done they will do a couple more mammogram views. You will have what looks like a small cut on your breast which they will put a steristrip on. I was told to keep ice on it that evening until I went to bed and to take tylenol. The people where I had it done were VERY nice and explained everything as we went along. I hope this has helped.

[mona17]

please explain to me the procedure for the sterotactic biopsy.  are you able to go to work after the procedure is done, how long does it take, is it painful?