Steriotactic versus open biopsy

[wendyot]

I went for a steriotactic core biopsy today.  After 3 attempts to position my breast, I was told I had to have an open biopsy because the space between the end of the needle and the cluster was too small and it could not be done.  The radiologist was going to do only one of the 4 clusters since it was the most suspicious, but then advised me that 2 should be done by the surgical route.  Has this happened to anyone on this forum?  The surgeon says she doesn't "always know if a biopsy is technically feasible until the patient is actually placed in the stereotactic biopsy machine".  I was in the bloody machine for 2 hours while the attempts...and multiple films were made.  Has this happened to anyone else on this forum?  What kind of prep needs to be done for the open biopsy?  Is it a local anesthesetic or general? I am totally bummed by this.

WendyOT
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[Ray515]

Hi-
I was told by my radiologist that he wasn't sure if a needle biopsy would work or not due to the area he would have to reach.  He gave me the option of trying the needle biopsy or scheduling an excisional biopsy which he knew would work.  I opted for the excisional biopsy because I didn't want to mess around with something that only "might" work.

I can honestly say that the excisional biopsy was not a big deal.  I told my husband that I had headaches that hurt worse than the recovery.  I started in the mammo machine where the radiologist inserted a wire to help guide the surgeon to the correct area.  It wasn't painful because the breast had been numbed, but it was a little uncomfortable due to the position I needed to be in to get a correct placement.  I was then sedated through an IV and the surgeon did his thing.  I slept through it all and left the hospital an hour later. I had a small drain in place that the surgeon removed in his office one week later.  The incision was very small and, more importantly, I had my answer less than one week later.  Go get your answer so you can take care of this.

[momzr]

I had a similar experience to yours.  I went to my annual mammogram - although this was first time I had a digital - and had left my boys at the shopping mall telling them it would probably take an hour or so.  Well, THAT did not happen.  After taking several views and discussing that they had seen a 'new' cluster of microcalcifications, they took me to the room where they had the sterotactic biopsy table/machine for a "fitting".  I was on the table probably at least 20 minutes to 1/2 hour and as I'm laying there trying to be still my cell phone is ringing in my pants pocket as they boys are calling to find out if I'm coming back to get them at the Mall because it is now over two hours later!  I was VERY frustrated with it all and was deemed too small for the stereotactic to work.  I DID go on to have a surigical biopsy with wire-guided assistance and did not find it 'bad' to go through.  Would I CHOOSE to do it again - of course not, but it was very tolerable.  After my biopsy it was discovered I had a VERY tiny area of DCIS (1.6 mm -- less than 1/8 of an inch).  It was not directly "in" the microcalcification cluster, so in hindsight I am glad we went the surgical biopsy route and got it out.  My margins were also clear and at this point I am having no further treatment of any sort since it was so tiny, margins clear, no invasive elements or agressive cell structure type.

I don't think it wil be a really bad experience for you to have the surgical biopsy either.  Here's hoping you will also end up being in the 80% whose findings are benign!

[braveheart2]

I have had a similar experience to japdip, and must admit that after my successful sterotactic core needle biopsy I had more pain and bruising (and an uncomfortable hematoma) than I had after my open excisional biopsy. I had a wire-guided excisional biopsy that was done with a local anesthetic prior to wire insertion, followed by the excisional biopsy which was done with a local plus sedation to make me relaxed...I slept through the whole thing, and woke with no pain. I worked on the computer from home that afternoon, and was back at my job in the clinic the next day, only needing a Tylenol the first night for comfortable sleep.

Best of luck, and do keep us posted as to how things go for you...

[japdip]

What you describe didn't happen to me but I did have an open biopsy. It wasn't a big deal and I must say I much prefer this to any of the needle type biopsies. It is done in outpatient surgery. In addition to the local anesthetic you are given some IV sedation for the procedure. I didn't know a thing !! A small incision about 2-3 in. in length and my Surgeon prefers beneath the skin sutures that are absorbed ... so no suture removal later. I personally had no bruising or bleeding or swelling after surgery. A little sore as with any cut anywhere on your body. Since the biopsy will be of microcalcifications and not an actual lump there may be a very fine wire placed at the proper area before surgery. This will be done in the Radiology Dept. under some sort of X-ray guidance before you go to surgery. Please keep in mind that this may OR may not be done; this will depend on your individual case and your Physicians.  Kindest regards..

[PaulMD]

Hi.

Though much technology has been developed to make non-surgical biopsies more feasible and successful, there are still exceptional cases where it is difficult to proceed with biopsy and there may really be no choice but to do an open biopsy.

an open biopsy is a minor operation where local anesthesia is employed.  this would require making an incision on the skin and getting the entire lump through dissection.  No special preparation is needed.  I would suggest you discuss this at depth with your surgeon and make sure you understand all the risks involved.

Regards.