Saturday, September 13, 2008
A New Topic for Here and There: My Stereotactic Breast Biopsy
Well, I should back up a bit. In July, when I had my annual mammogram, I received a letter from the radiologist saying that their results were abnormal and that they recommended a diagnostic mammogram and ultrasound. Because the same type of thing happened to me last year, I thought I knew what to expect -- another more rigorous mammogram and ultrasound of the breast with the offending abnormalities, then another check in six months, and that would be that -- just like last time.
Unfortunately, things inside my left breast have changed. After the diagnostic mammogram and ultrasound were taken, I had a long wait for the radiologist. At the facility where I have my mammograms, they use a triple-check procedure. The tests are examined by two radiologists, then run through a computer test that finds whatever they don't. It's a pretty sophisticated system, so they tend to find things very early.
Things like microcalcifications. So, when the radiologist who examined my films called me into a dimly lit room with nothing in it but two chairs and a small table, I felt a little panicky.
She told me they had found calcifications in two areas of my left breast. Then, she explained that calcifications are normally benign, but because the ones in my breast are clustered in two specific regions, they would need to biopsy the two areas. Then, I glazed over for a while.
Eventually, I was able to focus on what she was saying and started writing things down. The first thing I'd need to do would be to see a breast surgeon. She recommended one right down the road from me at the Cancer Institute of New Jersey at the Robert Wood Johnson Medical School, UMDNJ. Then, I'd need to have the biopsies done. The radiologist began to explain how they would perform the biopsies at their other facility.
She said the stereotactic biopsy (see the photo at the beginning of this post) takes place in a sterile environment, but is not surgical. I would lie face down on a table, with my head turned to one side, while my breast would hang through a hole in the table and the interventional radiologist and her assistants would perform the procedure. While I'm on the table, they will compress my breast into a different kind of mammography machine that will pinpoint exactly where the microcalcifications are. Then, they numb my breast.
After the breast is numb, they will use the coordinates from the computer attached to the mammography machine to take the samples. First, they make a tiny nick in the skin. Then, using a hollow needle attached to a vacuum, they will take 10-12 tissue samples from each section of microcalcifications. Next, they insert tiny steel markers where they extracted samples. If the surgeon has to go back in and take something out, she'll know exactly where to find it. Then, they send the samples to the lab, and I'll get a call from the surgeon in a few days with the results.
I was pretty discombobulated when I thought about the procedure. My first thought: "That's so barbaric!" Then, I realized I'd have to make some calls. I had time though, since the radiologist had to make copies of all my films to take to the breast surgeon.
While she was making prints of the digital mammographies and ultrasound results, I went out to my car and called my awesome gynecologist. One of her nurses recommended the same breast surgeon the radiologist recommended, so I needed to find out if she was in our health plan. Next, I called John.
John was at work, but he did a lot of research while we were on the phone. He found me the info on Dr. Kirstein at the Cancer Institute and listened while I explained as much as I could remember from the radiologist. He also gave me alternatives in our health care plan if I was unable to schedule an appointment with her. I was fortunate though, I scheduled an appointment for a few weeks after my call.
By the time I'd finished using up my cel anytime minutes, the films were copied and I could be on my way. What I really wanted to do was go home, turn on my computer and find out exactly what this all meant. That, and cry.
What I found out was microcalcifications could mean a variety of different things including cancer, benign cysts, evidence of old breast injuries, or other benign conditions. Last week, when I met with the breast surgeon, she told me that as cells die, they leave behind calcium deposits. When many cells die and microcalcifications form (especially in clusters), we need to find out why they are dying. Hence, the biopsies.
All that to say, my procedure is scheduled in two weeks. And, I'm a bit nervous about it. First of all, I'm really afraid of needles. I've gotten more accustomed to people taking my blood since I've had quite a few blood tests this year (for another, very treatable condition). But it all still freaks me out.
Second, it's going to suck. Two hours of being uncomfortable, needles, potential hematoma (read: bruised, purple boob for a week), and discomfort afterward for up to 48 hours. Ugh.
Oh, and there's the waiting for the results. But at the moment, I'm more anxious about the procedure itself. The doctor was pretty confident that the results will be benign, and I'm with her. Positive thinking. Now, if I could apply that to the stereotactic biopsy, I'd be in good shape. I'm just not there yet.
However, I'm glad I know what's involved so I know what to expect. The scheduler at the facility said that they will talk to me the entire time, telling me what's happening and what will happen next. I found that profoundly comforting. These folks are professionals. They do this procedure all the time. I keep telling myself that.
John, very soundly I thought, pointed out that it's just two hours. I've been through much worse over longer periods of time. He's right. I need to remember that. In the meantime, I've made a commitment to share my experience on this blog. It's not just for me though. What I continue to find is that the more I talk about this, the more women say they've been through some measure of breast biopsy, lumpectomy, cancer, or other situation.
My cousin Cynthia explained that because mammography devices have become so sensitive, they are picking up much more than they used to and have increased the number of procedures exponentially. The good news is that if, God forbid, it does turn out to be the worst-case scenario, they will have caught it very early. At this point, my calcifications are tiny, only millimeters in size. And, early detection is the key to breast conservation and survival.
On that happy note, I'll close with one last thought. Self-examination is great, but you can't feel calcifications like mine. If you're like me, in your late 30s and think you might be too young for a mammogram, think again. Go get checked.
If you've been through this or anything similar, please leave a comment and let me know. I'd really like to hear your experiences.
Photo credit: Provena St. Mary's Hospital
Posted by Deb Schiff at 7:11 AM