stereotactic biopsy

[LMT3]

I am 57 y/o - postmenopausal - On 10/3 I had my yearly mammogram. I got a call back a week later for recheck on my left breast. I didn't know until I got in there that they found microcalcifications. I got nervous when they walked me back to talk to the radiologist and needless to say when he started pointing out the calcifications and showing me the three clusters, one in particular that had the most in it, talking about the shapes etc. He was quick to say most of these tend to be benign but again he started talking about the shapes and something to do about the edges. Needless to say I could think of no questions for him, he did telll me to contact a surgeon as soon as possible for a biopsy. There is no history of bc in my family, that I know of, but other types of cancer in my father's side of the family. In Sept I just had 4 pre-cancerous polyps removed from my colon. Now this. My surgeon has me scheduled for a stereotactic biopsy in 11 days, thru her I found out the cluster with the most microcalcs is at 10 o'clock but no one has mentioned anything about BIRADS ratings (or if they did I missed it). I am very nervous about this, my father died at age 57 of cancer, my brother thinks he has testicular cancer (at least he has a lump that has grown over the last 4 years that he has ignored no matter what signs he has. With what I am going thru he has decided he better get that checked out sooner than later. Thank God.) But I live alone with no family and I am not as cool and calm as I try to let on that I am. Could someone please help me understand this stuff?       lauraT

[marydenise]

Hey, just chill. I KNOW this is all frightening, but it get's less frightening.

I've been through this mill for 5 years, by now. In August, 2006 they successfully cut out a 2cm IDC tumor. And in August, 2007, my MRI said Birad 1, on the X-Cancer breast. With no Radiation or Tamoxifen.

I just refused, those treatments. Why?

If they've found your breast cancer, from calcifications, it's REALLY small. Worst case, it's DCIS. A pre-cancer. Best case, it's nothing.

Have the Stereotactic biopsy, and find out.

[LMT3]

I just checked my pre-op orders and what I am having is the wire loc incisional biopsy. I schedule all my yearly things at the same time, this year my 5 year colonoscopy fell in time with everything else. My doctor said he wasn't expecting anything from this as I have had nothing but clear ones for the last 10 years. This year I had 4 polyps that were precancerous, 2 of them really on the border of being cancer. Then just days later I get the results from my mammogram. I have friends that have had breast cancer (one had single mastecomy one had a double one had chemo and radiation another that just had radiation), and a friend that has all different kinds of cancers. I have been there for all them, supportive and encouraging even when they felt awful, but when I think this is me my mind just blanks. My family all live out of state, my mother is coming up for Thansgiving and will be here to go with me when I get my biopsy results. People tell me the type of biopsy I am going in for is very painful but I have a high tolerance for pain, that isn't what bothers me. I don't understand anything that has been said to me except when I talked to the surgeon. She comes highly recommended on breast matters. It's just the waiting.

[trixie567]

DCIS (ductal carcinoma in situ) is a cancer not pre-cancer
ADH (atypical ductal hyperplasia) is a pre-cancer

There is a difference between stereotactic & incisional biopsies, I had a stereotactic one about 2 weeks ago and was fine didn't feel anything & went a lot smoother than I was anticipating...we always fear the unknown and until you get through it I am sure none of the stories you read will help too much, I hope mine does a little. Like yourself I had a cluster of microcalcifications at the 11 O'clock position that had a BIRADS 4 rating- I was scared to death. I have no family history and this was my first mammogram ever, I am 40! My results came back all benign and you can barelt even see where the procdure took place.

Like I say though an open incisional one is diff. but from what I have read there is no excruciating pain- you should be completely numbed up, you may want to post another question asking about the other biopsy. Good Luck & hope you get good results!!

[marydenise]

"DCIS (ductal carcinoma in situ) is a cancer not pre-cancer"

I guess opinions differ, because not according to Dr. Susan Love:

"What is ductal carcinoma in situ (DCIS)?
As more women have gotten mammograms on a regular basis, DCIS has been found far more often. DCIS is a noninvasive precancer. It is not life threatening. If you have DCIS, it means that you have abnormal cells in the lining of a duct. While virtually all invasive cancer begins as DCIS, not all DCIS will go on to become an invasive cancer. An invasive cancer is one that has the potential to metastasize (spread). Right now we have no way to determine which DCIS will go on to become invasive cancer and which will not. That's why doctors recommend DCIS be treated."

http://www.susanlovemd.com/breastcancer/

[usaangel]

EXACTLY marydenise.. DCIS is not a Pre- Cancer... trixie567 is giving false information. I suggest she goes to educate herself before giving facts..
I just recently had a stereoatic biopsy after findings of Clustered microcalcifications showed up. Biopsy was nothing, don't let people scare any of you. I had Birads 4 Suspicious. I have no clue about the Oclock? It said i had  approximately 2 cm group of linear pleomorphic calcifications to the right inner central breast mid depth.
I just got my results this week and will need surgery. I was diagnosed with PRE-Cancerous DCIS.
I have found many educational sites on this. I look at this like it was a Blessing that it is in my Duct & not growing. I will have a LUMPECTOMY http://www.breastcancer.org/treatment/surgery/lumpectomy/index.jsp
After this is done I will have radiation & then go on a Estrogen Blocker hormone med.
DCIS is currable.. Over 60,00 in the USA alone were diagnosed with this last year.
I have done ALOT of research on this.. So I suggest that people get the RIGHT facts before posting.
We all need to better educate ourselfs. Breast Cancer is just soooo common in women these days.. BUT THE blessing of it now is, with yearly mammograms things are detected early (like my DCIS) before it's to late!! Good luck to everyone..

[trixie567]

First of all, accusing someone of not having the facts right is WRONG! Are you a Doctor ? DCIS is so contraversial it's ridiculous & the "C" in DCIS stands for Carcinoma, carcinoma is a cancer whether you wish to call it PRE is up to you, it basically means that its in place iside the duct-just because it has not spread outside that ductal lining does not mean it's only abnormal cells, they can still be cancerous cells but "in situ" "in place" I would imagine if you polled 100 breast surgeons including Dr. Susan Love you would get 50 calling it a cancer & 50 calling it pre-cancer.

I have educated myself very well Thank You & I have read most of Dr Love's book but again you will have different opnions on everything from diagnoses to treatment. I have read where many women have bi-lateral mastectomy for DCIS or they go the route your going.Take HRT's for example-I have been on them for 10 years now and my surgeon claims they are A-ok but if you listen to Dr. Love she will say something very different and says they are bad long term & will increase your risk of BC.

I am sorry to hear that your diagnoses was that of DCIS, but since you are so educated I certainly hope you got a second opinion (especially on the path report), considering up to 30% of DCIS diagnoses are false positive or misdiagnosed.

I was not trying to start an arguement here, I was simply stating what I believe it to be and offer some kind words for LMT3 since she is quite scared right now.

LMT3- I am sorry that for some unfortunate reason there has been some posts that have gotten off subject here for you. I believe you will be fine for your biopsy & I wish you the best in what is a very scary time right now.

[marydenise]

We all have different, opinions. And personally, although I rather question the judgments of women who choose bi-lateral mastectomies, with a DCIS diagnosis, that is what is best, for them.

For my part, I value, my breasts. They're a part of me. And I'm going to do whatever I can, to keep them.

As I've said, I had an IDC diagnosis, and lumpectomy and I'm fine. And no further, treatments. It could come back, but if/when it does, cut it out, again. I'm fine, with that.

February 1, 2008 I'm getting Diagnostic, computer, mammos on both breasts, and another MRI in July, 2008.

After five years of dealing with all of this breast cancer, ****, after surgically cutting the cancer out, EVERY study has said, if you do the extra treatments, or  not, there is NO difference, in life expectancy. Check breastcancer.org.

So my  thought ... Why do them. And I didn't. And I will never do them.

But just another clarification, re ADH, MY surgeon, anyway, said that ADH is a greater risk factor, for breast cancer, but NOT a pre-cancer.

usaangel, I don't know your particular breast cancer, story.  But sounds like you've been through, a LOT.

Just wishing the best, for You!

[marydenise]

Oops, sorry, meant to address my last message to trixie567, And NOT usaangel.

Sorry, usaangel!

marydenise

[LMT3]

I have read some things that have said DCIS is cancer and others that say precancer but that it is in the ducts AT THAT TIME. It also said it could move outside the ducts and that is why further testing is necessary. Both of my friends that had the mastecomies had actual lumps not the microcalcs. The one that had the double mastectomy her mother had been diagnosed with breast cancer 15 years ago when she died she had been cancer free for over 6 years. But my friend never took care of herself, never had mammograms, never did self breast checks nor even annual visits to a gyn. She just felt the big bump one day when she was taking a shower. In her case she had no choice but the double mastecomy. The friend who had the single mastecomy had been on HRT for a long time and her doctor told her that's what caused her cancer. I had a hysterectomy when I was 29 (my uterus was literally falling out) but I retained my ovaries so I still had my cycles. But I was put on HRT (1.25 mg of Premerin) starting when I was 43 until I was 52. My Gyn says I am post-menopausal. I would not be receptive of going back on HRT because it caused my pancreatitis (it's why I went off them).  One of the reasons this is so scary for me is because my father died of cancer when he was only 57 (obviously not breast cancer colon cancer) and this all comes on top of finding precancerous polyps on my September colonoscopy (2 of the polyps were worse what the doctor says was borderline).  I take everything y'all are saying in, with comfort. I know everyone has a view and everyone's experience is different. Everything I'm hearing is actually helping me cope and the waiting easier. I also keep doing research. The more I know the more informed I can be it will help so that I won't blank out when I need to be paying attention.

Just want to say thanks to all of you that respond. After my biopsy I will let you know how that went. My sister is concerned because her sister-in-law had a wire loc and said it was exteremly painful. I have a high tolerance for pain so that doesn't scare me. I am researching right now what treatment will/would be if it turns out to be DCIS. If I'm prepared for what to expect with my luck (of when I'm ready it's not needed) I will get a negative reading. My fingers are crossed.

[LMT3]

that message is for trixie567, usaangel and marydenise

[marydenise]

Wow, a hysterectomy at the age of 29? Eek. You really HAVE been through the mill. AND pancreatitis? And you do have a lot of family cancer history, to consider. ALL, not good.

Yet, you're doing the right thing, now. Researching, and listening to all of our disparate opinions, on this board, and that's exactly what you should be doing. Reading and finding out, everything, and in the end?

Doing what's right, for you. Which you will do. Which we all do.

And just for my part, the wire loc is NOT painful. Ha, even though I had mine at the University of Washington Teaching Hospital/The Seattle Cancer Care Alliance/The Fred Hutchinson Cancer Care Center. In Seattle, Washington. And this Resident that did my wire loc was like a beginner. They had to try, like 3 times. But the Attending, was there, and again, it did not hurt, at all. I actually have a very low threshold, for pain. But it was fine.

It won't bother you, at all.

You're going to do great, LMT3. And most likely, it will be a negative result.

Ha, just don't worry about it. I had two months before they told me I needed this extensive biopsy, until I had it. Just don't think about it!

Once it happens, you'll then know, for sure

Just one other comment, Breast Cancer, at THIS stage, is almost NEVER fatal.


marydenise

[LMT3]

Funny you mention the UW, I'm having my biopsy done at Valley Medical in Renton WA. I have high confidience in their doctors there. The surgeon that is doing the biopsy has removed my gallbladder, placed the feeding tube I had during my pancreatitis episode, and removed a lipoma (fatty tumor noncancerous) from my arm. My mammogram was done in their Women's breast center. They just started using the new digital machine. So I feel very lucky on that.

Valley Medical Center is also a teaching hospital and some times I prefer the residents because they actually listen to you. Maybe being 57 that means a little more but they have never made me feel like I am a neurotic female. But I feel very fortunate for my doctors there. I

t was actually my surgeon that said told me that at most this could be DCIS, but that with the wire loc biopsy what ever the results it would be almost 100%. So if it comes out negative then there would be no second guessing. The cluster at 10 o'clock is the largest with the most microcalcs in it and the radiologist said that is the one they would likely use to do the biopsy. There were 2 other clusters but there weren't as many in them. So if they turn out to be positive would they have to remove all 3 clusters or leave 2 with more frequent mammograms? I haven't seen anything on that.

[marydenise]

Hey, sounds like Valley is great! You certainly are in, good hands. And that's great that they now have the digital mammography.

I'm convinced, the only reason there was this "calcification's threat" on my left breast, August, 2007, was because that was the first digitial mammo, on that breast. Before that, I'd had film mammos, at Swedish.

I HATE Swedish. My June, 2006 2CM IDC diagnosis, on my right breast stemmed from a false-negative stereotactic biopsy result, from them, in November, 2002. They told me, it was nothing, 3.5 years later, IDC breast cancer. Jerks.

But even the Seattle Cancer Care Alliance/University of Washington Medical Center, for both my lumpectomy, last year, and my surgical biopsy, this year, the system is just ... not right. First, you have to go to the SCCA, for the wire loc, and THEN, get someone to cart you down to the UW Surgical Pavilion, for the surgery. 6 hours, later.

This is just like ... NOT right. I'm sure you don't have to do that, at Valley, or even at Evergreen Hospital, in my neck of the woods.

This "state of the art" facility should not operate, this way.

But anyway, yes, it is true. Your worst case is DCIS. And to repeat, again, Totally Curable!

We are NOT Elisabeth Edwards, with a Stage 4 breast cancer that has spread, when discovered, by a LUMP. She took hormone drugs and never had any mammos, at the age of 53..

Those are the people that die, from breast cancer.

NOT us. The ones that get mammos, and microcalcification diagnoses.

We're the ones, that survive.

[LMT3]

Well actually my wire loc is kind of like that. I check into the hospital surgicenter at 8:30a, they take me to the Women's Breast Center (all connected within the hospital tho) at 10a, then my surgery is scheduled for 1p. When the doctor gets a sample they will send it back to the breast center for x-rays and the pathologist to see whether the sample she got has the microcalcs, then if it does it goes to pathology, if not she tries again until she does but all in one setting. I get the results a week later at my post-op.  

I didn't like Swedish either the couple of times I was there for tests on other things. I'm quite happy with Valley.

That's what my research has said, that if the path comes back positive and they do the lumpectomy, or whatever, thats it because DCIS is non-invasive. If they miss some it has the chance of coming back so I think you have to be really confident in your doctors. But you better belief I will be doing whatever my doctors tell me to. I don't think I will be happy if they tell me I have to take Tamoxifen tho. I have been thru a lot and I have beaten a lot already so I will this too, IF it turns out positive, but I'm praying for a negative.

[marydenise]

So, how did your biopsy go? I hope it went well.

I'm almost thinking, in the future if this ever comes up, again (micro-calcs) I'm just going to go right to the surgical biopsy. You were actually lucky in not having to go through both. Although, probably in your case, it was because you multiple cluster sites.

Anyway, wishing you luck on your path results! When do you get them?

For my part, in my "waiting week" I just kept telling myself worse case scenario it's DCIS. And it's VERY treatable and you'll be fine. That worked until the week was coming to an end, and then, despite myself, I got nervous. But then, the All Clear!

Here's hoping you hear the same, RSN!

[LMT3]

My biopsy was Monday. Went really good. My breast is bruised but I guess that is to be expected. During the placement for the wire it was tedious because they had to keep taking new mammo shots to make sure they got the blue dye and the wire in just the right place. I didn't even feel the shot that put the numbing stuff in. The actual surgery the anesthisiolgist and take about the different methods of anesthia and decided on local (in otherwords they put you in a twilight sleep). My surgeon also said she was surprised that the very first sample they sent to be xrayed actually had the microcalcs in it because my breast tissue was very dense and the microcalcs were more or else dead center. But I felt so good I even went into work for 4 hours the next day. I did ice my breast for a couple of hours that night but as I said it wasn't bad. My surgeon suggested that I wear a bra for support for a few days and to wear loose clothing so that is what I have been doing.  

I get the results on Monday the 19th. So I really feel I am ready for whatever the results are. My mother is here and she will be with me. I think that helps take some of the scary away. I will let you know on Monday what my results are. I am soooo glad your results we good.

[marydenise]

BUMMER, about the bruising. I had that, with my August, 2007 stereotactic, and it sucked. And five years, ago, with another stereotactic, I had a major hematoma. And my August, 2006, lumpectomy, man, MAJOR bruising/hematoma. My boob was like an entire, bruise, and with the SNB, it went down my back. Even my surgeon, she said, EEEK! When she saw me, a week later.

Three months, later, it was all fine.

And with my October surgical biopsy, NADA. NOTHING. NIL. I iced my breast the entire night, but nothing ever happened. By now, the incision is just this 1 inch line that will go away.

My lumpectomy incision, 14 months ago, it's hardly noticeable.

Although, for my part, I had the same surgeon doing my surgical biopsy that had done my lumpectomy. And she told me, in the pre-op appt, she was going to take Extra Care, to insure, no bleeding. And she did it.

I love her. She succeeded.

But ha,for my part, I did nothing, for the next five days. Told my job, in advance, I'm not going to be in.

Please do, post your results, when you get them. I'm so glad your Mother is there.

LMT3, you WILL get through this. By now, it's just a few more days ...

[LMT3]

Well I wasn't as lucky as you. I came back positive for DCIS. But the good thing is we caught it at a really early stage.  This is what it said: 1) Ductal carcinoma in situ, cribriform type (I looked this up, it means the cells are arraned in a sieve-like pattern) with low nuclear grade and microcalcifications, 4.0 mm in greatest dimension. 2) Surgical margins: Ductal carcinoma does not involve margins but extends to 1.3 mm of superior margin, 2.6 mm of anterior margin, and 8.5 mm from posterior margin (closest margins).

I am going in on Wed to have my lumpectomy. This way the surgeon can reuse the same incision, but rather than a local I will have to be totally under because the biopsy leaves a pouch that the numbing medicine has a tendacy to fill up in.  I will talk to a radiation therapist but I think what I will end up doing is the lumpectomy and keeping a watch on it with more frequent mammograms. Dr McFall said there is only 7% chance of re-occurance with the lumpectomy and getting radiation only reduces it to 3.5 -7%.

[marydenise]

BUMMER!

Because now you have to have the additional surgery.

But from how you described your pathology report, from what you wrote it said, "Ductal carcinoma does not involve margins." That says, to me, there were clear margins, but Dr. McFall isn't comfortable, with the margins. Yet, there WAS a margin. I think they are just being safe, which is good.

And again, we're talking mm's being cut out, for you, not cm's. 1cm is less than 1/2 inch. I can't even quantify 1mm. But, this is So Small. They probably won't cut out, much more.

Of course, it does depend on your breast size. With my August, 2006 2cm IDC lumpectomy, she cut a LOT out. Because I got Wide margins. But then, I'm a 36DD. By now, my X-Cancer breast looks great. Even, naked, it's hardly noticeable.

And yeah, talk to the radiation therapist, but I just say, don't do it. It's not worth, the side effects. I didn't do radiation with my 2cm IDC lumpectomy. I got way clear margins, with my lumpectomy. I accept the risk of recurrence. If the cancer recurs, I'll deal with it, then. Last August, my Cancer Breast was BiRad 1. From both the MRI AND the digital Mammo.

Although, from reading these boards, apparently a lot of women, don't want ANY risk. And get bi-lateral mastectomies, for DCIS. Not to mention, IDC. Eek. I don't get that, but to each, her own.

But sorry, off the soap box.

At least, you know. By Now. And you've got the surgery scheduled and it will be fine!

The General anesthesia is more than the Local, but IMO, just slightly more. You just need more recovery time.

I'll be looking for your posts, as to how it goes. The lumpectomy and the subsequent pathology.

I'm sure it will be fine. Just sorry, you have to go through this.

Mary

[LMT3]

Well the lumpectomy went even better than the biopsy did. The first day I had just a little discomfort, more like a pinching than a pain. No new bruising. Dr McFall said it went so well she didn't even recommend radiation, just more frequent mammograms for awhile. She surronded the area with small clips so they could see the area plainly on the mammograms.  

I can't tell you how much this board helped me. When I first heard the word "abnormalities and calcifications" I was so worried and scared. Now I am very confident that there will be no re-occurance and if there is I know the procedures.

Good thing I don't have to worry about the small size that had to be excized from my breast. When I was in my teens and 20's I barely filled out a 32B. As I got older, I got heavier and finally went up to a 44 but barely filling in the C cup. The incision was made along the areola so unless I do my regular and keloid it shouldn't be noticable.

Thanks Mary

Laura

[marydenise]

Laura, I'm so GLAD it all worked out so well!

And ha, even with my benign results, I'm on the "more frequent mammogram schedule," as well, for a while. Probably, for a long while.

Like you.

But that's totally fine. Maybe like you, after all of this, the more frequent mammos just result in getting anything caught, earlier. And by now, I'm totally up, for that.

If they can cut it out, do it.

And, IMO, that's very good that Dr . McFall didn't recommend, the radiation. Because you don't need it. Everyone told me that I needed the radiation, with my 2cm IDC, but I did not agree.  In my view, it comes back, again, cut it out, again. I have a high risk tolerance. After already getting cancer.

I'm comfortable, with the recurrence risk. I was NOT comfortable, with the radiation side effects. It wasn't worth it, to me.

But just, again, I'm so happy, for you! Now, it's done, now you can just live. You've been through the mill, and emerged, on the other side.

Have a great Holiday Season!

Mary

[LMT3]

Got the results from the lumpectomy. The rest of the microcalcs they got out were benign so I'm clear. YaHoo ;-) ! She did say that on Monday they met with the onocologist [guess this is a routine Monday meeting when all surgeons who have treated anyone for BC talk about continuing treatments]. He agreed I didn't need the radiation but he suggested a treatment of Tamoxifen. Dr McFall and I discussed this in some detail before my surgery and I said that treatment was out and she told the onocologist that. So it's just a mammo for the left side only in 6 months.

Laura

[popcorn3]

When it comes to the breast I would not let it go even if you just go to the family doctor and let them check it and give you advice.  Hope you make out well and just keep researching.

Sincerely,

Popcorn3

[marydenise]

Laura, benign, GREAT!

Doesn't it just give you a whole new lease, on life? After all that you've had to go through. All of this ****.

Well, it did for me.

And that Tamoxifen issue. That first came up with my right breast 2cm IDC diagnosis/successful lumpectomy/WIDE margins, in August, 2006. After I refused the radiation, I met with the oncologist and she basically said, "Well, if you refused the radiation, the Tamoxifen isn't going to help you, much."

And so, I didn't do it. And I feel great about it, to this day. It was the right choice, for me.

If my breast cancer comes back, I'll deal with it, again. Cut it out, again.

Although, it was interesting. My negative left breast October 2007 surgical biopsy results, (no cancer, no nothing) came after the August 2007 stereotacic diagnosis of ADH.

But then, after the surgical biopsy, again, negative, for anything, my surgeon outlines my options. Which were:

1) Continue 6 months monitoring. Mammos/MRIs
2) Take Tamoxifen
3) Have a bi-lateral mastectomy

The 3) caused great astonishment. To me! That had NEVER been discussed, even with with my 2cm IDC.

I guess she had to say it, to me, so that it would be in my medical record. So, I wouldn't come back and sue her, if the breast cancer, recurs.

Or whatever, I don't know. Again, I just find it sad that IMO, too many women do get bi-lateral mastectomies. For nothing. Because these doctors frighten them in, to it. A Mastectomy for some 2mm DCIS.

In the end, I'm choosing for myself. And everyone else is too.

Just choose, wisely.

Mary