Stereotactic Breast Biopsy

I recently had a stereotactic breast biopsy with a titanium clip inserted to mark the spot where the tissue was removed.  I was told by the Radiologist/Surgeon that it wasn't necessary to confirm the exact location of the clip after firing, only to ensure the clip was fired.  Is this true?  I have read elsewhere that a mammogram should be taken after insertion to document the exact location in the event of "clip migration."  

[japdip]

I believe I answered your concern in your previous post. The entire procedure is done under mammographic guidance so there would be no doubt as to where the titanium clip was placed.

[Sheriannz]

Perhaps if I provide more detail we can get to the heart of my question.

At the end of the stereotactic biopsy procedure the technician asked the Doctor if he would like a mammogram of the clip location.  He responded, "No that won't be necessary."  When I later asked him about his response he said Mammograms are often taken in the vertical position to document the location of the clip.  

[japdip]

OK, well that is true and there would really be no reason to ck. the location of the clip now since the biopsy had been completed. It will be ck.d at the time of your next mammogram. They are  left in place for future reference to the correct area.

[Sheriannz]

OK You agreed that mammograms are sometimes taken in the vertical position to document the location of the clip following biopsy.

That brings me back to my original question:  

When is it appropriate to have a mammogram in the vertical position to document the location of the clip following a stereotactic biopsy?  

(The fact the technician asked the Radiologist if he wanted a mammogram following the biopsy indicates that he sometimes requests one.)

[japdip]

I would think whenever your follow-up mammogram is scheduled. Each Dr. has his/her own routine for follow-ups after a biopsy. These follow-up mammos are not done specifically to ck. on the position of the titanium chip though. You might ask when your next mammogram should be done but I would think that you will be advised of this when you get the results of your biopsy from your Surgeon or your prescribing Physician.

[misawa47]

Hi, After I had my stereotactic biopsy TWICE, each different facility did do a mammogram after placing the titanium chip. They said they wanted to make sure it was in the correct place where they did the biopsy. In fact, the first stereotactic biopsy yielded no microcalcifications in their 20 samples. The second doctor reviewed my mammogram film after the first stereotactic biopsy and said the doctor wasn't even in the right area of microcalcifications for the correct tissue samples (from the titanium marker placement); hence the second stereotactic biopsy.
Bernice

[Sheriannz]

Thank you so much for confirming the fact that you had a mammogram immediately following chip placement at two seperate times in two different facilities.    The radiologist's failure to request the mammogram is one of many red flags surrounding my biopsy.

[japdip]

There are no red flags concerning the mammo or lack of .... they aren't always done and every Physician and Institution has a different routine for procedures.  

[Sheriannz]

If I may ask, have you personally undergone a stereotactic breast biopsy or participated in the procedure as a health care provider?

[japdip]

Not as a pt. .... I read your response on the CAD post also and I don't really understand about the wrong quadrant of your breast being biopsied .... if you mean exactly where the needle was inserted to obtain the specimen it isn't always inserted at the exact spot of the suspicious area. The needle is inserted at the point where access to the area can best be obtained. This depends on the angle and the depth of the area in question. Since this is done under mammographic guidance there is very little margin for error. Have you received the results of your biopsy ? I'm trying to understand why you have so many doubts regarding your procedure.      Thanks ..

[RITZGAL]

Hi,   A few weeks ago I had a stereotactic biopsy with clip and before I got up from the table, they said, "Just one more picture."  They explained it was to document placement of the clip.  So does that mean they want to make sure its in the right place?  Maybe.  But maybe taking a pic of placement depends on what was found on mam and where it was found.  But I do know now after a consult with a breast surgeon that the clip is used not only for a marker on subsequent mams, but it is also used as a guide for wire guided excisional biopsy if warranted by biopsy results.  In my case ADH was diagnosed and now I am having excisional biopsy. So I'm glad they put in the clip and took a pic.  Here is my humble opinion.  I think you should call your radiologist and ask how come they didn't take a pic after placement of the clip?  If you don't get a satifactory answer, ask your doctor.  Good luck.

[Sheriannz]

A sincere thank you to all of you for taking the time to respond to my questions.  I had no idea I would find this level of support or experience among "my sisters."  I'd like to start a new message stream entitiled Botched Biopsy? and lay out the facts as I understand them to be.

I look forward to your continued input, insights and encouragement.  

[japdip]

OK ... Let's hear it; I for one am very interested in the details. May I ask if you were treated at a Military Institution ?? If you would like even more input from women with vast experiences ck. out   (bcsupport.org) and choose the first section "Meeting Place for Survivors" and post there ... if you have the time I think you'll get some interesting info and comments. A great group of women who have all "been there and back".    Take care .....