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


Destiny's Kitchen said...

I haven't had experience with this, but I am afraid of needles and medical procedures myself. I think it helps to close your eyes or look away. If I see that needle, that's when I feel panicked.

I will be sending you good thoughts! Try to stay positive and distract yourself with hobbies/books, especially while you're waiting for results. Hang in there. :o)

Deb Schiff said...

Thanks for your kind thoughts and wishes, Destiny.

I won't be able to see anything, actually. Better for me. :)

Anonymous said...

I am a breast cancer survivor of 7 years. I found my lump through self-exam, luckily while it was still in Stage 1. I am normally fine with needles but when I went to get biopsied I almost fainted on the doctor. It was actually pretty funny when I looked back at it. The biopsy didn't really hurt, it was more the fact that I was sure it was cancer that had me freaked. She did manage to get one sample before I almost blacked out. Luckily, or unluckily it was enough. I had just had a mammogram about 2 months before-hand and they did not find anything. After I found the lump I had an ultrasound and it did show up on there. I know there are women out there that think that self-exams don't work but they're wrong.
And you are right about women in their late 30's thinking that they're too young. I was 41 when I was diagnosed and a friend of mine was only 38 when she was. A nurse had told me that they are seeing more and more younger women being diagnosed.
Best of luck with your procedure.

Deb Schiff said...

Thanks, Debbie. I'm glad you shared your experience.

Anonymous said...

I just completed a 3.5 hour stereotactic Biopsy. I had no idea what to expect,but instead of painful, it was mostly just super uncomfortable and made me feel very vulnerable. My calcifications were hard to locate because they are close to the chest wall (so I don't think it normally takes this long), it took several tries to coax my right breast into just the right position. Holding completely still while my arms fell asleep and neck cramped up was no fun either.They really need to do something about the table it felt like plywood! The staff was great, but it was truly the most uncomfortble experience of my life.I am just thankful it's over and crossing my fingers I'll never have to do that again!

Deb Schiff said...

I'm so sorry you had such an awful experience. I totally understand the vulnerability and uncomfortable feelings. Next month, I go back for the 6-month follow-up and I'm nervous, but have faith nonetheless. I hope none of us have to go through it again. Keep the ice on your breast. It will help. Best of results to you!

Anonymous said...

Thanks for all your comments. I am schedule to have my first stereotactic biopsy on tomorrow Jan 5th. I am glad I found this site I had been searching for more information on this procedure as well as some comments from those that have actually experienced it. I am a little scared but after reading more and more and finding that my doctor explained it actually like you guys are telling. I have prayed and I do believe things will be okay.

Cottage on the Hill said...

Thank you so much for posting on this topic. I was told after my morning mammo on Friday that I would need this procedure on Monday, tomorrow. I am terrified. And I found your blog last night after sleeping for two short hours and then waking in a panic. I am so thankful for your posts and also the comments. I am going to hope for the best. I appreciate being able to hear from real people who have experienced this.

Deb Schiff said...

Dear Cottage on the Hill,

Thank you for taking the time to comment. I know it's a scary time.

I'm sorry that you have to go through the procedure and are terrified. Knowing what to expect (at least to a certain degree -- it's not the same as actually experiencing it) helped me, too.

Just know that you'll be very sore afterward, and that ice helps a LOT. I hope you have very helpful radiologists and nurses. I was fortunate to have very sensitive ladies working on me during the procedure.

Please let me know how it goes and what your results are. I'll be keeping you in my prayers.

Best of luck,

Alison Agnew said...

i just had
the exact same experience
two days ago at my second mammogram
and now
the biopsy is scheduled for next Monday

thanks for all the details
and off to read about your procedure


Deb Schiff said...

Thanks, Alison. Best of luck with your biopsy.

Anonymous said...

I had a very similar experience and had the biopsies just yesterday. It was much less painful and scary then I had imagined. Now for the results. Good luck.

Deb Schiff said...

Best of luck to you. Thanks for taking the time to comment.

Unknown said...

I had a mammogram done at 38 and was told tgat they found a calcification. I had some magnified views taken. The technician showed me the picture. What i saw was this one pin point dot on the screen. The technician told me that if this were to be "something", this was what they would want to find. She tokd me that i should call my primary in 2 days to get the results. I am a nervous wreck.

Anonymous said...

I am 38 yrs okd and had a mammo done because of discomfort in my breast. To my surprised i was asked to sit and wait. I believe that this was the longest 10 mins of my life. I was then asked to have some more slides to magnify an area where a calcification was foung. I was petrefied. After the magnified pics were taken the technician asked me if i wanted to see the picture. What i saw on the screen was a tiny pin point dot. The technician said that if this were to be anything worrisome, that that tiny pin point dot is what they would like to see. I was also told to call my primary in 2 days for the results. I feel so distraught and alone right now.

Deb Schiff said...

Hi Dasha,

I'm sorry that you have to wait two days to receive the results. What has helped me in times like these is to practice "just-in-time worrying," which means that until I know that there is a reason to worry, I make a decision NOT to worry. It's difficult and requires practice, but the reality is that even when they biopsied me, I still didn't know if there was anything to worry about. It is a lot of energy to expend for not knowing. In the end, I was very lucky, but other women who have commented here were not so lucky. I keep all of you in my thoughts and prayers.

Best of luck,

Anonymous said...

Had stereotactic biopsies in both breasts yesterday...[rocedure not that bad...very little discomfort afterwards. It is the waiting now that is on my mind, but the procedure itself is manageable good luck to you all!

Linda said...

BC stage 0 survivor 15 yrs mastectomy.Now new calcifications on other breast...terrified...have PTSD from last bc ..need biopsy going Thursday...have neck onjury. Not sure I can get thru this. Help

Linda said...

BC stage 0 survivor 15 yrs mastectomy.Now new calcifications on other breast...terrified...have PTSD from last bc ..need biopsy going Thursday...have neck onjury. Not sure I can get thru this. Help

Deb Schiff said...

Dear Linda,
I'm very sorry that you're going through it again now. You can get through this. You are a survivor and you have strength of spirit. My guess is that you also have a network of folks whom you can count on to during this time. If you don't have a therapist who you believe in, please try another. PTSD is no joke. Will be keeping you in my thoughts and prayers.