browser life

Since I have become experienced at receiving biopsies, I decided to put this knowledge to good use and write up something for But You Don't Look Sick. Here is my latest article:


Breast Diagnostics: Beyond the Annual Mammogram

As has been well-publicized, October is National Breast Cancer Awareness Month. There are reminders everywhere for women to get regular mammograms as this is the best prevention. What is less publicized is what happens when the mammogram shows a lump that needs more investigation.

If you receive word that you need further screening, do not panic. Many times, a second set of scans will reveal any abnormality to be a harmless cyst. And sometimes, the original mammogram was done incorrectly and comes back fine the next time around.

One thing to keep in mind is that pre-menopausal women are more likely to have breast tissue that is dense, making accurate scanning more of a challenge. Smaller breasted women have less fat in the tissue, so there is less visible difference between a mass and healthy breast. And up to 60 percent of women have fibrocystic breast disease, in which they develop non-cancerous cysts; endocrine disorders such as diabetes and thyroid disease increase the incidence of a fibrocystic breast condition.

If there is any uncertainty after a second screening, an ultrasound will usually be next. These are simple and painless and can usually be done at the same appointment. Ultrasounds make it easier to determine whether a lump is a cyst or a tumor.

Should an ultrasound be inconclusive or suggest a tumor, a biopsy may be ordered. These range from a fine needle aspiration, the simplest, to open surgery, the most invasive. The type of biopsy required depends on the nature of the lump, its size, and whether it is causing pain or other symptoms.

The main thing to remember about breast biopsies is that 80 percent of them are negative, meaning non-cancerous. While it is important to take a biopsy seriously, it is not worthwhile to lose sleep over that other 20 percent chance. Think of it as ruling out cancer if that helps.

Traditionally, all biopsies were done under general anesthesia, the suspicious area analyzed, and a mastectomy done if necessary all in the same day. Now this is uncommon unless a patient has circumstances that would warrant an invasive one-step procedure (such as a health condition that would prohibit multiple surgeries) or if there is some certainty that the entire lump must be removed. Outpatient procedures are preferred whenever practical.

I have had two biopsies. The first was in 2007, and the other was last week; both biopsies were of the needle variety, which I will detail in full as they are fairly common. As I do not have personal experience with open surgical biopsies, I will not go into them here, but the National Institutes of Health is a good place to start if you need more information on them:
http://www.nlm.nih.gov/medlineplus/ency/article/003920.htm

Fine needle aspiration can be done in a doctor's office; it uses a small needle to take a sample of the tissue in question and does not require anesthesia. It can also be used to remove fluid from cysts. It is usually only done on tiny lumps; on larger ones, it may not remove enough tissue for an accurate diagnosis.

Core needle biopsies can be done either in a doctor's office or an outpatient setting and uses local anesthetic. Multiple samples, usually three to five, are removed from the breast using a spring-loaded device; because more tissue is removed to analyze, it is more accurate than fine needle aspiration. Ultrasound or other scanning devices may be used as a guide to help with precision of placement of the needle.

Newer technologies allow even greater sample size than a core needle, thus ensuring even more accuracy but without the necessity for open surgery. A vacuum-assisted needle can be used to suction the tissue into a cylinder for analysis. This is similar to the core biopsy in that it is outpatient and requires only local anesthetic.

If you are told you will need a biopsy, you do not usually have to wait long to get one; some places can schedule them in less than a week. But if you are on medication such as blood thinners or NSAIDs or take supplements that have anti-inflammatory properties such as fish oil, you will want to wait at least three to five days to have a biopsy in order to give you enough time to discontinue or modify your dose according to your doctor's recommendation. You can replace your NSAID medication with Tylenol for three days prior if your doctor okays it.

Another thing you will want to do prior to a biopsy is inform someone at the facility where you will be having the procedure, preferably a nurse,  whether you have allergies to latex, adhesives or Lidcocaine-type medications so they can accommodate you. Also call them if you may need an anti-biotic prior to the biopsy because of a cardiac condition, heart valve replacement or joint replacement. For my most recent procedure, I was given a new adhesive tape and steri-strips made especially for sensitive skin, and because of my intolerance of Lidocaine, they actually called my dentist to find out what local anesthetic she used and gave me something similar.

On the day of the procedure, stick to your usual meal routine, particularly if you are diabetic, so you won't have any glucose level concerns. You are not required to have someone drive you; however, you might want to opt for this if you live a long distance away and have a fatiguing condition. If you are working, you might want to take the rest of the day off if possible because you will be instructed against any strenuous activity or lifting.

For convenience, wear an oversized shirt that is easy to put on and take off because it will go over a dressing later. It is recommended that you wear a bra, but you might want to avoid a tight-fitting underwire; an old sports bra that will offer some support but will stretch enough to cover a dressing would be ideal. A sports bra will also be handy for holding ice packs in place afterward.

You will want to arrive a bit early for your appointment as there will be some paperwork and you'll need to go over your medical history and medications. If you are on a lot of meds, bring with you a typewritten list to save time. You'll also talk with the person who will be performing the procedure to make sure you understand it and answer any questions.

You will be asked to take off everything from the waist up and put on a hospital gown that opens in the front. You will make a mark on your skin above the breast that will have the biopsy to make double sure they choose the correct one. Now you're ready to get started.

You'll most likely lie on a table for the procedure at whatever angle will make it easiest to reach the area being biopsied. In 2007, I was on my right side, but during the one I had last week, I was on my back with a foam wedge under my shoulder. If there is something you need to be more comfortable, like a pillow under your knees or a warm blanket over your legs, just let them know.

If this will be a guided procedure, they will perform an ultrasound or other scan to pinpoint exactly where the needle will go. They will try to determine where the edges of the lump are and, if it is a core biopsy, decide how many samples to take. Your breast will be sanitized.

Unless you are doing a fine needle aspiration, you will be injected with a local anesthetic, usually a fast-acting one. Some women say they don't even feel the injection. But if you have a chronic pain condition like fibromyalgia, you may notice it.

If you are nervous, close your eyes and do whatever relaxation technique works for you. Focus on deep regular breathing and not tensing up. You may feel some pressure as the biopsy needle goes in; if you feel sharp pain, let them know as you may need more anesthetic.

The incision from the biopsy needle is pretty small, a quarter inch or less, so there won't be many stitches, and you may not even end up with a scar. When the sample or samples have been obtained, pressure will be put on the area for up to 10 minutes to make sure there is no bleeding. You may need to have post-biopsy mammograms; these should not be too uncomfortable as your breast will still be numb.

Afterward, you will have steri-strips over the incision, and gauze will be taped over that. If you opt to not use adhesive tape, alternatively, you can be wrapped in an Ace bandage to hold the gauze in place and support your breast. You will be given post-surgical instructions; read over these before you leave to see if you have any questions you need answered.

Ice packs are recommended for the next 24-48 hours, replacing them with fresh ones every hour or two. This may sound excessive, but if you are prone to bruising, it will really help. If you experience any pain, you can take Tylenol, but hold off on any NSAIDs for a day or two. If you need stronger pain relief, consult your doctor for advice.

Take a break from exercise and housework like vacuuming for a couple of days. If you can tolerate it, continue wearing a bra even at night for 48 hours. Providing support and avoiding excessive activity during this time frame will help you fully heal.

Keep the bandage dry for two days. I find that removing the dressing and adhesive tape is easier on my skin if I soak it in the shower first. The steri-strips may need to stay on an additional day or two; remove them the same way, or if they are not bothering you, leave them until they fall off by themselves.

The pathology report on the tissue sample is usually ready within three business days; I've gotten them in just 24 hours. If it comes back normal, you may not have to do anything further except a follow-up mammogram in six months. If you have a problem that requires treatment, you will be instructed how to proceed.

Biopsies are less intimidating once you know how they work. This will help you save your energy for whatever diagnosis you might receive.