Ultrasound-guided breast biopsy - what's involved

Today I underwent an ultrasound-guided breast biopsy, so thought I would write it up to explain what's involved, in case any of my readers has to go through it.

Why

The reason is that a change to an existing cyst was found on my annual mammogram. It may or may not be something to worry about, but there's no way of telling without taking a tissue sample, so the next step was to have the biopsy. 

Before the procedure

I was given a drug called Atarax to take on the evening before the procedure, and again on the morning of the procedure. It's an anxiolytic - reduces anxiety - but also an anti-histamine and reinforces the pain relief. It absolutely knocked me for six, and I was warned that someone else would have to get me to and from the hospital. I also had to have a blood test the week before, to check that I coagulate properly, which might be an issue for some, and you can't take any form of aspirin-like drug, which might cause bleeding. 

How to prepare

The morning of your biopsy, don't use any perfume, deodorant, talc or lotion on the relevant breast or armpit. These can cause 'artefacts' and skew your test results. Wear a bra, as it helps to hold the dressing in place, and take a squishy coldpack with you, to apply afterwards. I wore a sports bra, which is both soft and supportive. You obviously have to remove the upper half of your clothing, so a skirt and top is the easiest clothing - getting into a comfortable position is more difficult in jeans. I wore a knit skirt.

What happens

The kind of biopsy I had was ultrasound-guided, because the lump was fibrous. If it's more of a hollow or fluid-filled cyst, you might have a fine-needle aspiration done instead, where a long, thin needle is pushed directly into the breast, without anaesthetic, and a fluid sample taken. 

In the ultrasound-guided procedure, you lie on the couch and have your normal ultrasound examination, so the radiologist can see exactly where the lump is, then you have to get into a position where he or she can use the ultrasound device at the same time as inserting a needle. 

My radiologist was male, and assisted by a female nurse. I was asked to lie on my side, then twist to about a 45 degree angle, with my left arm above my head. This was quite difficult and I was glad of the yoga session I'd done that morning. 

After being cleaned with alcohol, then dressed with betadine, my breast was covered with a disposable sterile paper sheet with a hole in it, to isolate the wound site. The lidocaine injection stung like a bee, but didn't last long, and then the radiologist pushed and prodded around a bit to spread the injection fluid. This didn't hurt, but you do feel a bit like a piece of meat. 

One thing that did amuse me a bit was that he put the ultrasound device inside a sterile rubber glove in order to use it. 

Then a small cut was made through which to insert the biopsy needle. This is ENORMOUS - like something you'd expect to use on a horse - which was slightly alarming. Although it is about a foot long, most of it, however, is holder - the needle itself is about five inches long, and it goes up and down, grabs some tissue, with a loud clicking sound, and then withdraws. You don't feel any of this, and it isn't reinserted each time, put pushed through a cannula-type device that remains in place in the breast.

Three tissue samples were taken in my case, and each took about a minute (little bits of bloody tissue were dropped into sterile pots, yuk), then the cannula was withdrawn and the radiologist applied a lot of pressure to stop any bleeding. The wound was then dressed with a clear dressing, something like clingfilm, which I can shower in (though I won't). 

I then got dressed and went and sat in the waiting room for about ten minutes, and then my dressing was checked to ensure there was no bleeding. The radiologist was surprised that I'd brought a coldpack to prevent a haematoma, but said it was a great idea, and I've been glad of it as the day has worn on. I haven't needed a painkiller yet, but will probably take one for sleeping.

Afterwards

I now can't do any lifting or sports for two days, though I can go swimming on Thursday evening as usual - the dressing can come off on Wednesday.

So, I now have a week or so to wait for the results, and will go back for another consultation the week after next.