What they Didn't tell me about my Breast Cancer Biopsy

OCTOBER 31, 2013

Journal Dump #002

The biopsy experience.

What they don't tell you:

1. Maybe they will, maybe they won't... but no one told me not to take any motrin, asprin or vitamins, prior to having a biopsy.  I live with chronic headaches so I eat motrin like candy.  The only acceptable pill before a biopsy, is tylenol.

2. I was told: "It doesn't hurt at all, you might feel just a pinch".  BIG FAT LIE!  Read below for what really happened.  But be prepared because it hurts!  I don't want to scare anyone because the biopsy is a crucial part of this process and can't be avoided but I wished I had known the truth so I was prepared.

My experience:

After having a mammogram and an ultrasound and then an MRI, it was time for my biopsy.  My girlfriend has been by my side, holding my hand for every dr visit and every appointment I have had to date.  At this biopsy appointment, they wouldn't allow her to come in the room with me.  I had an Ultrasound guided core biopsy and the whole process took about 20 minutes.  Two nurses and one doctor in the room.  The doctor did the procedure and the two nurses made sure I stayed very still.  One of the nurses continually gave me shots that apparently numb the area - DOESN'T WORK!   The big tears flowed as I laid as still as possible until it was over and then the nurse pushed on my boob with a towel, with a lot of pressure, until the bleeding stopped.  That hurt too!  If I get the guts up, I will post a photo of what the area looks like after a biopsy, and all the bruising.

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My actual report results of the MRI, Mammogram, ultrasound & biopsy:

FINDINGS FROM THE BILATERAL MAMMOGRAM:

There is heterogeneously dense breast tissue, type C density bilaterally which limits the sensitivity of mammography for detection of cancer. Behind the nipple of the right breast seen on both projections is an ill-defined isodense irregular mass measuring approximately 2.0cm in diameter with associated architectural distortion and nipple retraction. This appears to be associated with some linear and branching type irregular microcalcifications. These calcifications appear to be lobularly distributed. While there are scattered calcifications noted in the left breast, they are more numerous in the right. Additionally, the mass has a small irregular larger calcification associated with it. There is a lobular more circumscribed lesion in the 6 o'clock position of the left breast measuring 1.5x0.8 cm. No other lesions on the left are identified. There is no lymphadcnopathy. There is no left nipple retraction or skin thickening.

FINDINGS FROM THE BILATERAL BREAST ULTRASOUND:

Right breast ultrasound demonstrates a large hypoechoic mass measuring 2.1x3.4x2.5cm at the 7 to 8 o'clock position, 1.0cm from the nipple, corresponding to the lesion identified on the mammogram. This lesion is taller than it is wide, demonstrates irregular margins and has vascular flow with some areas of posterior acoustic shadowing. There is an adjacent 1.0cm cystic component arising off the lateral aspect of the lesion. There is some architectural distortion noted. The lesion does cause some thickening and distortion of the adjacent skin.

Left breast ultrasound demonstrates a simple cyst at the 6 o'clock position, and a complex cyst at the 6 o'clock position, 4.0 cm from the nipple measuring 11x10x7 millimeters. No concerning lesions are identified.

Impression: Lesion within the right breast suspicious for neoplasm. There are lobular distributed calcifications also noted, also suspicious for lobular involvement. A biopsy is recommended for further assessment.

MRI is also recommended.

Classification: BI-RADS 4 - SUSPICIOUS ABNORMAILTY

ACR Breast Density: C-Heterogeneously dense

Result code: BR 4 C

FINDINGS FROM THE MRI: 

The patient received 15 cc of Multihance. 

FINDINGS: Right breast: A marker was placed overlying the palpable abnormality in the 9 o'clock position of the right breast in the periareolar region. Heterogeneous fibroglandular tissue is seen. Multiple cysts are seen measuring up to 8 mm in size. Nipple and areolar retraction is seen with deviation of the nipple laterally. A 2.8 x 2.2 x 2.4 cm mass is seen under the marker in the retroareolar region projecting toward the 9 o'clock position with spiculated irregular margins located 2.6 cm from the nipple and 7.4 cm from the chest wall and 1 cm from the skin surface. The mass has mixed kinetics with areas of plateau and washout. No other areas of abnormal enhancement are seen. No other masses are seen. No intraductal enhancement is seen. Significant lymph nodes are seen. The chest wall is unremarkable..  Left breast: Heterogenious fibroglandular tissue is seen. Multiple cysts are seen measuring up to 1.1 cm in size. No dominant mass or suspicious parenchymal or ductal enhancement is seen. No significant lymph nodes are seen. The chest wall is unremarkable.   Right breast strongly suspicious for underlying breast carcinoma.   Left breast benign findings with fibrocystic changes.  BI-RADS Category 5 - Highly suggestive of malignancy - appropriate action should be taken.

REPORT FROM THE ULTRASOUND GUIDED CORE BIOPSY:  (RESULTS NOT IN YET)

The skin was prepped and draped in the usual sterile fashion. Under direct ultrasound visualization, local anesthesia was applied at the skin entrance site using a 27 gauge needle. A small skin incision was made. A 12 gauge ATECH vacuum assisted biopsy needle was positioned within the mass and biopsy was performed. 8 vacuum assisted core biopsy specimens were obtained.