Breasts: Ultrasound, biopsy, wires-- specifics . . who decides?

 From the time I got the callback for more mammograms, I stumbled around trying not to think about it, but thinking about it. After I got my clothes back on, a doctor explained that my films were in a "grey area" and I should get a "needle biopsy." He made a little sketch to explain, and I was not enthusiastic about what I saw.  The procedure room had a sign "stereotactic biopsy." More terms, more new words, not enough deep breaths.  Another room had a big sign "Ultrasound."  Why couldn't I just have that instead?

 Last week I saw an American Medical Writers blog that said ultrasound is used to place the stereotactic biopsy needle and also the guidance wires for surgery. Since I had no ultrasound as any part of my DCIS diagnosis, I feel skeptical when people seem to feel ultrasound and mammo might be interchangeable.

I finally emailed Becky Lambert, who was the tech for some of my diagnoses including the placement of wires for my lumpectomy. (Her education and specific experience had impressed me, and at that time, she'd kindly agreed to give me her email address.)  

She answered:  (the underlining is mine)

"There are 2 ways we do Core or Needle biopsies in the Breast Center, Stereotactic Biopsy and Ultrasound Biopsy.  Stereotactic breast biopsy is Mammography-guided, using x-ray.  We also  biopsy using Ultrasound when the lesion is seen well with Ultrasound. Small calcium deposits (microcalcifications) are seen easily with mammography and not seen well using Ultrasound, so calcifications are usually biopsied using Stereotactic equipment.

Both Mammo and Ultrasound are used to place wires into the breast prior to surgery to guide the Surgeon as to what to remove.  This procedure is called a Needle Localization.  Lesions that are seen best with Mammography are localized with Mammography.  When a lesion is seen best using Ultrasound, it can be localized using Ultrasound.  Our radiologist decides which method is preferable for each situation."

Since I was diagnosed with DCIS, which can't be found by manual exam, I'm glad I showed up for the mammogram that started my diagnosis.

I wish you health.