From the moment my gynecologist said there was a suspicious area in my left breast, things started moving really, really fast. I had my first appointment with Dr. G just a few days later. She was going to review the images and decide if I needed any tests, but other than that, I had no idea what to expect. Dr. G said that based on the images, which showed what she called an area of clustered micro calcifications[1] we should have a stereotactic core needle biopsy.[2] I had an appointment for this biopsy in less than a week.
The morning of the biopsy, I was feeling very anxious. In part, because even though Dr. G had described it in detail, I was still having trouble imagining what it would be like. But mostly, I was anxious because I was getting tested for breast cancer. Even if you don’t have any breast cancer in your family, it is hard to go into a procedure like a breast biopsy without some degree of anxiety. That morning, I prepared my bowl of cereal, set it down on the kitchen counter, and my kitten Stanley jumped up, flipped it into the air, and spilled milk and cereal all over the kitchen floor. In retrospect, this is a funny moment, but at the time, it only added to my anxiety.
While MG and I were in the waiting room, her Mom came by to wish us luck and to tell us not to worry. I hadn’t told my own mother about what was happening. She was still very demented from her own health crisis, but even if she wasn’t, she had never been the kind of Mom that I would talk to about things like this until after they were over, if at all. So to have MG’s Mom there for us was very comforting.
Hearing the details of how the biopsy was going to work was one thing, but actually going through it was very different. For one thing, there was the table. It was a wide table, pretty tall, with a hole at one end. The nurse prepping me for the biopsy had me climb up and lay face down on this table and put my left breast in the hole. This hole was then closed until it was a clamp around my breast, basically anchoring me to the table. This is to keep the breast from moving during the procedure. It felt as weird as it sounds, but it did not hurt. The radiologist used computer images of my breast to help him find the cluster of microcalcifications, and then used the computer to guide the machine to take out tissue for the biopsy. I asked to see the images before the procedure, and frankly, the cluster was so microscopic I couldn’t believe anyone ever noticed it. It made me really appreciate the technology of mammography, but also the skill of the radiologists who reviewed the images.
The Novocain they used to numb my breast started to wear off during the biopsy, probably because set-up for the test took longer than usual. They gave me a second shot, which kept my breast numb, but which also caused a pretty strong physical reaction. My body started getting twitchy, and I started getting emotionally upset and agitated.
Novocain numbs the area where you inject it, and it contains epinephrine to minimize bleeding. Unfortunately, I am sensitive to epinephrine, although I didn’t know this about myself before the biopsy. The second shot was a little too much for me. When it kicked in, I started twitching so much that the attending nurse had to hold me down on the table by my shoulders. When the biopsy was over, she had me turn over on my back so that they could ice the biopsy site. I was still shaking all over, and I didn’t understand why, so I started crying pretty hard. I felt hysterical. Luckily, the nurse was very patient and understanding, and she let me cry myself out. We talked about the test, about my fears about the results, and about what I had been through with my Mom during that summer. After a while, she figured out that part of what was happening to me was a reaction to the Novocain, although part of it was clearly my anxiety about the test and about my Mom’s health.
After a few minutes, I was able to calm down enough to get off the table and return to the changing room. After I was dressed, the nurse bought me out to MG in the waiting room. She explained about my reaction to the Novocain, and made sure that we both understood the instructions on how to take care of the biopsy site and what to do if I had any problems. They call these “aftercare instructions” and you need to understand them so that you don’t get an infection, and so that you can recognize signs of infection if you develop one. They always warn you about the potential for infection, and the potential for excessive bleeding. I’m sure this is because these risks are very real, but none of these things ever happened to me, although I felt like MG and I were prepared for the possibility, because we made sure to understand the aftercare instructions for every procedure or surgery I had.
I was still a little jittery when we left, even as we were walking out to the car, but about five minutes into the drive home, the jitters passed, as did much of my emotional upset. This convinced me that most of my reaction to the biopsy was caused by the epinephrine in the Novocain. This is a good thing to know about yourself – since then, I have had my dentist use Lidocaine, which is Novocain without epinephrine in it, and I have learned that I am not nearly as anxious when I am getting fillings as I used to be.
Physical recovery from the biopsy was pretty easy. The procedure only leaves a little incision and some bruising and swelling, which is minimized by the epinephrine in the Novocain. The nurse had given me this little ice disk, about 2 inches across, which I could tuck right into my sports bray, and I used it to ice the incision site every hour or so, and I took some Ibuprofen for the pain. I was able to return to work in a couple of days. My breast surgeon had said the results would be back by a specific day, so MG and I planned to meet up at my office and call her together for the results. MG came over to the office, we took my cell phone outside, and called the surgeon. I remember that it was a nice, clear summer day in early August. We got Dr. G on the phone, and she told us that the biopsy had revealed what she called “atypical ductal hyperplasia[3]” or precancerous tissue in my breast. It was her recommendation that we go to the next step, a surgical biopsy, to remove all of the precancerous tissue from my breast.
As scary as this news was, she sounded pretty confident that the odds were in my favor that this would not turn out to be a diagnosis of breast cancer. So, we set a date for what she called an excisional or surgical biopsy, which is also known as a lumpectomy. This time, based on the amount of anxiety I had before and during the core needle biopsy, I requested some medication for anxiety, and she prescribed one Xanax pill, half of which I was to take the night before the procedure, and half that I would take that morning. The biopsy itself would be done in the outpatient surgical center in her office building. My sister E and her husband came into town the night before, to be with MG and me the day of the surgery. After the surgery, they would stay with me at the house for the afternoon, so that MG could go back to work.
[1] Breast calcifications are calcium deposits inside the breast which appear as white spots or flecks on the mammogram image. Microcalcifications appear as extremely fine white specks on the image, are usually benign but can sometimes be a sign of breast cancer (Mayo clinic).
[2] A core needle biopsy is a “through the skin" (percutaneous) procedure that involves removing small samples of breast tissue using a hollow "core" needle. For lumps or lesions that can be felt by hand, this is accomplished by fixing the lesion with one hand and performing a freehand needle biopsy with the other. In the case of non-palpable lesions (those unable to be felt), stereotactic (computer-guided) mammography or ultrasound image guidance is used. Stereotactic mammography uses computers to pinpoint the exact location of a breast mass based on mammograms taken from two different angles. The computer coordinates help the physician to guide the needle to the correct area in the breast. With ultrasound, the radiologist or surgeon watches the needle on the ultrasound monitor to help guide it to the area of concern. The needle used during core needle biopsy is larger than the needle used with fine needle aspirations (usually done in your doctor’s office), and has a special cutting edge.
[3] Atypical hyperplasia is caused by a disruption in normal cell growth in breast tissue, which causes an over-production of normal-looking cells that accumulate and begin to look abnormal. These cells can develop into ductal carcinoma in situ, or noninvasive breast cancer in the milk duct. This can develop into invasive cancer, which can invade the surrounding breast tissue, lymph channels or blood vessels (Mayo Clinic).
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