Stereotactic Bopsy

I'm scheduled for a stereotactic biopsy on thursday. My surgeon tells me this can be really painful. He said he wouldn't use deep local because that can move the cluster. I have a papable lump that I found myself and cluster microcalcifications on my mammogram. I have had 2 fibroadenomas removed in my left breast about 10 years ago. The problem is with my right breast. I'm 39 and I have a strong history of BC in my family. My mom was 41 and a cousin was 32. My Grandmother just had a mastectomy last year at age 83. I opted for stereotactic biopsy instead of excisional because the surgeon seems to think the palpable lump is "just breast tissue". I guess my question is how painful is this kind of biopsy and how accurate is it? My fear is that they miss the area of microcalcifications. Any info would be appreciated. I think this is a wonderful site for those of us who are scared and looking for info and support. Thank you.

[CCF-RN,MSN-JS]

In stereotactic biopsy, computer-assisted X-rays allow the biopsy needle to be precisely positioned, especially for smaller lumps or lumps that cannot be felt.  Special mammogram films are taken of the site to be biopsied.  The radiologist uses these films and, with the assistance of a computer, calculates the exact location for needle placement to obtain the biopsy.

The procedure begins with cleansing the skin and applying a local anesthetic to numb the skin surface.  The radiologist then introduces a sterile biopsy needle.  Additional X-ray films are taken to confirm accurate needle placement.  Tissue samples are obtained through the needle.  It is standard procedure for the needles to be inserted three to five times in order to obtain an adequate tissue sample, this portion of the procedure takes ten minutes or less.  The biopsy site is so small, a Band-Aid is usually all that is applied, and a woman can resume her normal activities after the procedure is completed.  The entire procedure takes about one hour.

There are cases in which stereotactic core biopsies shouldn't be done, such as if the microcalcifications are more scattered and chances of missing the area are greater, or a radial scar that if not removed entirely it might be difficult to diagnose a small piece.  Other considerations if a person is over 300 pounds wouldn't fit on the machine, a person needs to be immobile lying flat face down for as long as 45 minutes, so if you are unable to do that this might not be the procedure for you.  Not being able to get adequate pain control should not be a problem, and I would ask your surgeon or the radiologist who is doing this procedure about this issue again, and what is meant by really painful, it should not be a "really painful" experience, uncomfortable, some soreness after the local anesthetic wears off but not "really painful".  

At our institution once the specimen is obtained they check it under x-ray immediately to make sure they have microcalcifications in the specimen.  This way they have more assurance that they were able to get the correct area in the specimen.  If no microcalcifications show up in the x-ray they can get another specimen right away.

[filmgrrrl]

I had a stereotactic biopsy in August after microcalcifications were seen in my mammogram.  I had heard that it could be painful, but in my case, it wasn't really painful at all.  I took an ativan 1/2 hour before the procedure to relax and had no real problem.  I recall lying on the table for an extended period of time was the worst of it.  It may depend on what area of the breast they have to biopsy.  My calficifications were at the 12 o'clock region.  They took several samples and then looked on the xray to make sure they had gotten the califications.  It turned out I did have DCIS.  Good luck to you, I don't think it will be too bad.

[mtsure]

I too had a stereotactic biopsy three years ago. It was THE MOST PAINFUL experience I have ever had. I had a 10 pound baby naturally and this was more intense than that. Why does it have to be so painful? I would love to hear from people who have had this procedure with out this intense pain. I now am facing another stereotactic and I am not sure I can do it. Are there alternatives? What about an MRI instead? My diagnosis is microcalcifications. Doesn't that show up in MRI? Has anyone had a second stereotactic?

[Scrunch]

When I had a stereotactic biopsy about six months ago, the procedure did not hurt at all.  Laying on the table (I call it the "torture rack", for the period of time that it took was what was painful, in that I have a lot of arthritis.  When it was over, I had a hard time sitting up and took a while to be able to get off the table and onto my feet.  There was a little soreness afterwards in the area where the procedure was done, but was nothing unbearable. That was my experience, anyway, though others' may be different.  Good luck and God bless!

[Bet63]

Thanks for the info. Sorry to hear that you have DCIS. The watiting is terrible. Do you know how your microcalcifiactions were clustered? I saw my mammo and they look pretty tightly clustered. I don't know if that makes a difference or not.
How soon did you learn your results from the biopsy? (please let me know if I'm being too personal here....I'm just looking for some insight from someone who has gone through what I'm going through) Anyway, thank you again for your comment. It is REALLY appreciated.

[Bet63]

Thank you so much for the info. The surgeon said some women tolerate the pain more than others, that he's had some that want to jump off the table and others have no problem. I'm hoping I have no problem. I don't have alot of fat in my breasts and therefore not much cushioning. Is the way the cluster is formed (tighyly or more scattered) give an indication or clue as to whether or not its cancer?
Thanks again for your help.

[Binkie]

It was indeed satisfying and gratifying to read Binkie's post on the lack of
merit and danger
of x-ray mammograms.  It is well documented that ionizing radiation from
mammography can and does induce breast cancer.  There
has never been a credible study showing that
mammograms reduce the death rate through early detection.   All of the
recent studies on
this subject have been fatally flawed.  An x-ray mammogram is merely an evil
marketing
strategy by the profiteers to cause breast cancer to subject more women to
expensive
procedures and drug.   Even some of the breast cancer drugs are known to
cause cancers
in other organs.  Women are rarely, if ever, properly counseled on what is
contraindicated
when taking certain anti-cancer drugs.

Low-income women have the lowest incidence of breast cancer without
exception.  Yet,
many hospitals and the mainstream breast cancer organizations routinely
target them with
free mammograms.  This is simply a novel marketing strategy to induce breast
cancer in
them to create a larger pool of women for expensive treatment to be paid by
insurance
companies and the tax payers.  Further, many hospitals, cancer treatment
facilities,
healthcare providers urge both healthy women and breast cancer survivors to
engage in
activities known to cause breast cancer.

Contrary to what is taunted by the American Cancer Society (ACS), breast
cancer is
essentially a preventable a preventable disease.   Through the years, women
have been led
to take what the ACS and the National Institute of Health (NIH) say as
gospel.  They
should be aware that both the ACS and NIH receive large sum of many of
money, directly
or indirectly, from the offending breast cancer industries, namely, alcohol,
tobacco,
petrochemical, drug, cosmetic industries -- to name some.   Also, many of
the editors of
mainstream medical journals have financial ties to the offending industries.
Consequently, information useful for breast health is rarely published if it
is deemed to
have an adverse impact on profits.

Therefore, it is unreasonable for women to place great reliance on advice
biased for
economic considerations.  Finally, most healthcare providers advocate breast
cancer
prevention.   What they are really talking about is secondary prevention,
i.e., preventing
the spreading of the disease not preventing a first occurrence.
Unfortunately, women
have chosen to support the illusive goal of finding a cure.   Finding a cure (aka 'racing for the cure)'
is well outside
the control of women singly and collectively.  Primary prevention in within
the control of
the individual woman.

Prepared and written by:

James Coleman, Ph.D.
President/CEO
Cancer Research Center of America, Inc.
www.CancerResearchAmerica.org

[filmgrrrl]

My microcalcifications were clustered...though it turned out it was fairly extensive in the breast so had mastectomy.  I was actually relieved to find out it was DCIS as that is a pretty manageable thing.   I found out the results from my biopsy the following day.  As I said, I was happy that was the diagnosis.  Good luck and take care....Through this whole ordeal I've found the waiting for the biopsy and path results to be the hardest part emotionally....surgery was simple in comparison.   I would recommend taking a look at Susan Love's book....she has excellent, up-to-date information on every aspect of breast cancer from biopsy through treatment...It helped to ease my mind as well.

[Bet63]

Thanks again for the information. It seems like every shred of information I get is like a gift. You're right about waiting for the biopsy and results IS the hardest part of all this.
I wish you luck and you have my gratitude for answering my questions.
Take care :0)

[mtsure]

So what do you suggest women do?

[Binkie]

Sure, I was copying a post by a Ph.d; I wasn't trying to suggest to anyone what they should do. That is up to the individual and what they believe is best for them and what their symptoms are.
For myself I intend to never get a mammogram. It's just my personal preference. Best Wishes

[filmgrrrl]

Well, in my case, my mammogram saved my life.  They discovered microcalcifications, and, after biopsy, DCIS.....after the mastectomy it was discovered that I had a tiny bit of invasive cancer .5mm, low grade...if left untreated, well, I don't think I need say more.  As it was the early detected allowed me to be treated with surgery alone, no chemo, no radiation.  I would urge every woman over forty to get a mammogram annually...but as you say, it's a personal choice.  I'm glad I made the one I did.  Take care all.

[Binkie]

What I would do is research and find out if a cancer is slow growing . As many know, prostate cancer can be so slow that most men dx with it die from something else. I believe that BC can exhibit the same prognoses. We all have cancers in our bodies; the immune system keeps it at bay. There are some conditions that doctors call cancer which are not really cancer at all. If you read about BC in John Lee, M.D.'s book, "What Your Doctor May Not Tell You About Menopause" you'll find that the "in situ" cancers are usually harmless. Fifteen years ago a doctor called me on the phone after a pap and said I had cervical cancer in situ and recommended a hysterectomy. My next pap was NORMAL. I never had the surgery and have had normal paps ever since. I am the worst sceptic imaginable. If anyone wants any quotes from the book I'll be glad to acccomodate. Do you realize that early cancers are "encased" in a shell? A shell put there by Mother Nature that I , for one, wouldn't want pierced w/a biopsy. Do you all know the rates of false positives and false negatives of mammography?
We are dealing with human beings reading these things. Humans are flawed and make mistakes. And cancer is Big Business. Did you all know that, in one survey, most cancer doctors said they'd never subject their wives to chemo and radiation nor themselves??

[filmgrrrl]

Like I said, each to her own....in my case I feel content with my treatment and decision.  I've studied human physiology and the biology of cancer while in college and feel as though I have a pretty good understanding of how the human body works--in fact I did a major research project on breast cancer treatment issues and the politics therein.  At any rate, each individual needs to sift through her options, talk to doctors, peers and family and make the decision that best fits her well being.  Take care.

[Bet63]

Binkie,

Do you realize that this site is to HELP and Support women? I'm sure most if not all the women who ask questions here are searching for answers to their questions and a little hope in a seemingly hopeless situation, not negative comments to make their fear worse. I realize you are entitled to your opinion but perhaps you should air it in a different forum. Personally I would not trade a moment of any mammogram or biopsy for the world if it meant that any cancer was found and treated. That's MY opinion.

Bet63

[Binkie]

Very interesting link to cancer survivors' stories who claim they cured their own cancer:
http://home.online.no/~dusan/letters/indexpage.html

[histotech]

You're not helping! I was enjoying reading about everyone bx experiences until I got to yours. Just an observation, but it seems that you have some unresolved anger that needs to be addressed. I hope you can work through it!

[histotech]

I had a steriotactic bx last Thursday. I had a cluster of microcalcifications on my left breast, and bilateral enlarged milk glands. I am 42. My first(screening)mammogram was abnormal last November so I had to go in for a bilateral diagnostic mammogram(a closer look), and an ultrasound. The ultrasound revealed many fluid-filled cysts, and the diagnostic mammogram showed (most likely) a benign not palpable growth. My grandmother, and my aunt both passed away with metastatic breast ca. Due to my family history, the radiologist suggested that I have a bx, it's the only way to be sure. I took two days off from work. They gave me 5 mg of valium. I now know, it was for the uncomfortable bed I had to lay in for about an hour. I was in a prone position(face down) and my left breast hung through an opening. The medical staff worked underneath me. I faced the wall, so I couldn't see what was going on, I just heard voices. They cleaned the area with betadine. The bx was not painful, I only felt a little needle stick when they numbed the area. They warned that they may leave a titanium clip in, in case the steriotactic was inconclusive. In that case an excisional bx will be next. Every bx(or group of bx's) was x-rayed to be sure the calcifications were obtained. When they were finished, I felt them cleaning off the betadine, and applying pressure to stop the bleeding. They put steri strips on the the bx site. I had a difficult time rolling over onto my side and then sitting up afterwards. I have lumbar spine problems. I had to put ice packs on for the rest of the day, and tylenol for any pain. I am not able to lift for 5 days, and the steri strips need to stay in place for 5 days. I'm supposed to keep the steri stips as dry as possible. This is the most difficult part for me because I usually go the the gym 3-4 x/week. So no spinning, no weight lifting, no steam room. I am waiting for my path report. I should get the results by Tuesday. The worst case scenario is that I have carcinoma in situ. In which case it is still confined to the breast, and I have caught it in time. At any rate, I feel by doing what I have done thus far, I am fighting to continue the quality of life that I have right now. Just by having a mammogram. I am a medical professional.So you see medical people get sick too! Most of us are only here to help sick people that need our help. The pay isn't that great. We have a calling to do the work that we do.

[Bet63]

Glad I'm not the only one who thinks Binkie is doing more harm than good here.
I had  my stereotactic which was unsuccessful. Due to the size of my breasts (on the small side) and the area to be biopsied. We gave it a heck of a try though. For 45 minutes they pulled and exrayed trying to get the cluster to show while I was on the bed of torture. I ended up doing an excisional biopsy with wire localization last monday. I see the surgeon tomorrow for follow-up. I thought I would have results by now but no luck. The waiting is pure torture!!
I hope you get good news when you get your results and if not then be glad  it was caught in time and is treatable. I am hoping the same for myself.
I also agree with you completely about the importance of regular mammograms. Keep up the good work.
Good luck and all the best to you.

Bet63

[AnotherRN]

I too recently had a stereotactic biopsy (1/30).  My experience was virtually the same as yours, except my biopsy was on the right breast whereby I was able to see the x-rays of the microcalcifications that they extracted.  Fortunately for me, I did not experience any pain with my biopsy.  However, lying on the table was quite uncomfortable and I had a moment of trouble getting up as I was much stiffer than I thought I was.  I'm very glad to have had this biopsy as I was diagnosed early with ductal carcinoma with tubular features.  (I am 43 y.o., nulliparous female with 5 tumors in my right breast and 2 in my left.)  I am scheduled for my bilateral mastectomy with reconstruction on 3/6/03.  Should everything proceed with the results we expect, I should be able to have surgery and be able to forgo the radiation and chemo.  However, the path reports that are usually available 2 days after the surgery will let us know for sure.  I definately believe in mammograms now.