Your mammogram was abnormal, and follow-up imaging didn’t provide all the answers. Now, your doctor is recommending a biopsy. At this point, you may be frightened, wondering: What does getting a biopsy mean? Is it painful? Does this mean I have cancer?
“Most women feel very alone, anxious and nervous when a biopsy is recommended,” said Dr. Nicole Abinanti, director of women's imaging at Mecklenburg Radiology Associates in Charlotte, who treats Novant Health patients. “It’s easy for others to say, ‘Don’t worry, relax! It's not a big deal.’ But it is a big deal, even if it is likely to be benign.”
In fact, 80% of women who undergo breast biopsies learn their abnormalities are benign, she said. Nevertheless, the entire process can feel stressful and nerve-wracking.
And there's fresh attention around the subject in light of Katie Couric's Sept. 28 announcement that she has breast cancer. Abinanti explains what you can expect before, during and after your biopsy.
Why do I need a biopsy?
Abnormal screening mammograms don’t automatically mean something’s wrong, but we occasionally need additional imaging to determine that. That’s why we call you back for additional mammogram images or an ultrasound.
Most of the time, the additional imaging shows only normal breast structure. Sometimes, though, we see a finding that needs a little further workup.
That’s when we need to do a biopsy, to define what's actually causing that abnormality. Statistically, for many findings, it is most likely going to be benign, but the biopsy will determine if breast cancer is present.
What IS a biopsy?
In a biopsy, we remove tiny pieces of breast tissue which are then examined by pathologists to make sure no cancerous cells show up. The radiologist will recommend the kind of biopsy that would be most effective for you, depending on what type of imaging shows the abnormality.
Most biopsies are performed with small core needles that allow us to collect 1- to 2-centimeter samples. Surgical biopsies, which are less common, involve a little incision that allows a surgeon to remove more tissue, if necessary.
It's time to schedule your mammogram.
How is a needle biopsy performed?
After you check in, during preparation, we carefully explain the procedure, and answer all your questions. Then, we use one of three types of imaging — ultrasound, mammography (usually 3D) or MRI with contrast — to guide us to the abnormality.
Next we administer a local anesthetic. Most patients say the shot feels like a little pinch with some burning, and the area numbs up within seconds. After that, most patients say they felt pressure while we took the samples — very rarely does anyone feel more than that.
After taking the samples, we usually place a small marker at the site, so if we find anything that needs to be removed, we can use an X-ray to confirm the precise location at the time of surgery. If the area is benign, the marker will show in future mammograms that the area has been biopsied.
The biopsy itself usually takes only 10-15 minutes for an ultrasound- or mammogram-guided procedure, or about a half-hour for an MRI-guided biopsy. Then we apply pressure, and provide an ice pack to keep on the area while we go over the post-procedure instructions.
How long will it take me to recover?
Everyone is different, but it’s common to have some bruising and to feel a little sore and achy at the site for a few days. Very few people require anything more than Tylenol for pain. We recommend regular icing for 24 hours after the biopsy.
Are there any risks associated with a biopsy?
Occasionally, a biopsy may cause a hematoma — a little bit of blood collection in the cavity where we removed the samples. Hematomas resemble bruises, and can cause a lump. But they are not uncommon or dangerous.
Also, any time you put a needle into the body there is a possibility of infection. We use sterile technique in everything we do, so the chance of infection is very rare.
When and how will I get the results?
Initial pathology results are usually available in two to three days. Sometimes, depending on the results, additional details may take a little longer to arrive. We always suggest patients meet with a nurse navigator — an advocate who is assigned to all biopsy patients — to go over the results in person or by phone, so they can ask questions and discuss their next steps.
Due to the 21st century CURES Act, it is possible for patients to view the results electronically as soon as they are posted. That can cause a lot of anxiety, especially if the biopsy detects cancer. So, even if a patient prefers to view her test results at home, a nurse navigator will call to go over the details and address any concerns.
What if it’s cancer?
If you are diagnosed with breast cancer, you will be assigned a nurse navigator who will stay with you throughout the entire journey. They can explain the full pathology report from the biopsy when it’s available, and answer questions about your diagnosis, care options and the type of cancer you have.
Nurse navigators also help you arrange an appointment with a breast surgeon, and continue to support you in navigating the treatment process, including:
- Scheduling additional imaging and lab work.
- Facilitating medical oncology, radiation oncology and other appointments.
- Referring you to a high-risk cancer clinic or for genetic counseling.
- Arranging complementary therapies like massage and acupuncture.
Unfortunately there’s no ‘magic bullet’ or ideal advice guaranteed to banish the stress of having a biopsy and learning the results. Having a good support system and talking to other women who’ve been through this can be helpful.
Also, we really want women to know that while this is a medical facility, we truly care about them. We’ll be here to help them get through the process. No matter what the outcome is, they will not be facing it alone.