stereotactic biopsy vs. MRI

[GracieMary]

I posted a question back on May 23rd wondering if I should have further testing.  In Nov 07 I had an abnormal mammogram.  It should a white spot in my right breast.  When radiology doc looked at it he said he wasn't concerned and to come back in 6 months for a follow-up mammo.  During this visit he felt a small lump, which he was also not concerned about.  I was concerned, so I had that lump removed.  All fine, it was benign papilloma.  I went back for 6 month mammo on May 21st.  The white spot is still there, not changed and he is still not concerned.  I am so I asked about an MRI and Stereotactic biopsy was recommended.  My concern is this...The breast tissue in my right breast is denser than the left.  Also, it feels different than the left and I can fell another small lump. I know that MRI's are used for detecting cancer in dense breast tissue, wouldn't an MRI be the most accurate way to go to be sure the spot or surrounding tissue are not cancerous?  Also, I just had a mole removed from the same breast and it is precancerous.  I know that breast cancer is different than skin cancer, but I am very nervous about both.  Any advice or guidance is much appreciated.

[Dr Santos]

Hi Ma'am,

Mammograms and ultrasounds look at the breast in different ways.  The mammogram is still the best way to look at all aspects of the breast for the lowest cost.  Ultrasound is not used to look at the entire breast but just a specific area of abnormality. That is why the spot was visible with the mammogram.

Take care and God bless.

[GracieMary]

Hello Dr. Santos,

Actually I did not have an MRI.  They would not do it. They said insurance would not pay for it and that it wasn't needed.  The spot that is visible on the mammogram is actually two spots, which was discovered from the additional views of mammogram.  Also, the spot doesn't show on an ultrasound.  Is it normal for a spot to be visible on mammogram, but not on ultrasound.

[Dr Santos]

Hi ma'am,
How are you? I hope you're fine after the MRI. July 9 is still about 3 weeks away, just keep yourself busy to pass away the time.
Here is another link that tells you what to expect for the stereotactic biopsy:
http://www.radiologyinfo.org/en/info.cfm?pg=breastbixr

Take care and keep us posted.

[GracieMary]

Hi Dr. Santos,

Thanks for responding.  I just went for a second opinion this morning.  The doctors are not concerned at all with the fact that both my breast are more dense than previous mammograms or that my right breast is more dense than the left. Both opinions basically said the same regarding false negatives with MRIs.  As for the spot, they did more views of right breast and found that the spot was actually two spots.  The doctor today did not seemed concerned about that either and said that he would do a biopsy if I wanted him to. I am scheduled for a stereotactic biopsy on July 9th.

[GracieMary]

Hi Greta,

thanks for responding.  I just went for a second opinion this morning.  The doctors are not concerned at all with the fact that both my breast are more dense than previous mammograms or that my right breast is more dense than the left. Both opinions basically said the same regarding false negatives with MRIs.  As for the spot, they did more views of right breast and found that the spot was actually two spots.  The doctor today did not seemed concerned about that either and said that he would do a biopsy if I wanted him to. I am scheduled for a stereotactic biopsy on July 9th.

[Greta_L]

Hi,
I'm a two year survivor who has had MRI and the stereotactic breast biopsy.  MRI's are good at locating suspicicious areas, maybe too good.  After they identify something, it doesn't prove that it is cancer.  My MRI found a "lesion" on my liver that I then had to have biopsied (not easy thing to do) and it turned out harmless.  I was told that for the breast there are a lot of spots that turn out not to be cancer and checking them all out can delay other procedures.  
The stereotactic needle biospsy was not terribly invasive though there is some pain or discomfort.  The results however are conclusive, which we all want.  They also left a tiny titanium marker behind so that in the future they know that spot has been checked, or if unfortunately a cancer, they can find it easier.  
I think you'll get better answers with the needle biopsy.  They MRI may raise more questions that will need more work to answer.

[GracieMary]

Dr. Santos,

thanks again for responding and answering my questions.  I called my doctor's office to inquire about an MRI and I am waiting for them to call me back.  Thank you for the website link.  It was very helpful.

[Dr Santos]

There is no doubt that MRI identifies foci of cancer that are not evident on physical examination, mammogram, or ultrasound.
In one study done, MRI was more sensitive than mammography for the detection of multiple malignant foci in fibroglandular or dense breasts.(http://www.ajronline.org/cgi/content/abstract/183/4/1149)  MRI would  certainly dispel some worries concerning the denser right breast, though these areas may be normal for your age.
Ultimately, your individual feelings, attitudes and values may be just as important as the facts in weighing your options. It would be best if you discuss this with your doctor.

And advance Happy birthday next month.:)

[GracieMary]

Thanks for responding Dr. Santos,  I will be 48 next month.  I appreciate you responding to my post, but I don't think my question was clear.  I have read up on Stereotactic biopsy and MRI's and I am wondering if the MRI would show more than the biopsy in a dense breast.  Also, I am kind of worried that the right breast is more dense than the left.

[Dr Santos]

Hi ma’am,

How are you? How old are you? Do you have a family history of breast cancer? I’m sorry to hear about the precancerous mole and the anxiety you’ve gone through. The dense areas which are breast tissue and are normal for your age appear as shadows or show up white on the mammogram. As a woman grows older the fat tissue becomes more prevalent in the breasts and shows up gray on the mammogram.
Magnetic resonance imaging (MRI) is a noninvasive, usually painless medical test which uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of the breasts and other organs. MRI is growing in popularity as an alternative to traditional x-ray mammography in the early diagnosis of breast cancer and has been shown to detect small breast lesions that are sometimes missed by mammography. MRI can successfully image the dense breast and if a suspicious lesion is seen MRI can provide guidance for biopsy. This link can help: http://www.radiologyinfo.org/en/info.cfm?pg=breastmr

On the other hand, a stereotactic breast biopsy is performed when a mammogram shows a breast abnormality such as: a suspicious solid mass, microcalcifications, a distortion in the structure of the breast tissue, an area of abnormal tissue change or a new mass or area of calcium deposits is present at a previous surgery site.The special mammography unit used to perform a stereotactic breast biopsy is a digital mammography machine. You can learn more about this through this link: http://www.radiologyinfo.org/en/info.cfm?pg=breastbixr

I hope this helps. Take care and keep us posted.