Patient Information

If you have an abnormal mammogram, then your physicians may recommend a biopsy. However, are you aware of the fact that there is a minimally invasive way to find out if that abnormality is breast cancer without having to undergo an expensive surgical procedure? Just as laparoscopic cholecystectomy revolutionized the way we remove diseased gallbladders, so has stereotactic breast biopsies the way we take out the tissue seen in abnormal mammograms.

With a stereotactic breast biopsy, which uses a needle to biopsy instead of a knife, you avoid the omnipresent scars and occasional depressions in the breast contour that are seen after open surgical biopsy. The technique is much faster than open surgery and has far fewer side effects in terms of infections and significant hematomas. The accuracy is comparable to open biopsy and, in some instances, better.

The procedure is much less expensive than open biopsy, since you won't need an operating room, an anesthesiologist, the OR nurses, pre-operative lab tests, EKG's, etc. No medications have to be given either.

Stereotactic biopsy is now available to all women, as long as they are in reach of a medical center serviced by MoBx, the nation's largest provider of stereotactic breast biopsy services in the mobile environment. That means MoBx provides the high tech stereotaxy machinery and exceptionally well trained mammographic technologists who travel to your medical center to perform stereotactic breast biopsies. No longer do you have to travel long distances to get state of the art treatment. Nor do you have to wait for your local medical center to buy its own equipment since MoBx provides all that your local physicians need for a highly accurate, minimally invasive stereotactic breast biopsy.

We hope the following information will answer all of your questions about what to expect.

 
If Your Mammogram is Abnormal . . .
     Special Studies
    Physical Examination
    Needle Localization Biopsy
    Stereotactic Core Needle Breast Biopsy
    Peace of Mind
 
Preparing for Your Exam
    Avoiding Medications
    What to Eat, What to Wear
Post-Stereotactic Biopsy Instructions
    Biopsy Results
    Follow-up Mammography
 

If Your Mammogram is Abnormal . . .

First of all, don't panic! Most abnormalities seen on mammograms are not cancer.

Fibrocystic changes, fibroadenomas and age-related calcium deposits can cause alterations in a woman's mammogram. These non-cancerous abnormalities account for 65-85% of all suspicious mammograms in many extensive studies. What that means is that the patient with such a mammogram may need further study, close follow-up or a biopsy.

Special Studies

Sometimes, an ultrasound examination (a form of sonar) can tell us whether a shadow is solid or cystic (containing fluid). A solid lump can be benign or malignant, while simple cysts are usually, but not always, benign. Unfortunately, ultrasound is of little use when the abnormality is a cluster of microcalcifications.

Calcium deposits are quite common in women's breasts, especially with aging. Large or scattered deposits are of no concern. However, when a cluster of microcalcifications is seen, there is a significant chance that a cancer is growing around these deposits.

Luckily, these changes frequently occur in very tiny cancers, so that early detection and treatment can mean cure in the vast majority of these cases.

One way of analyzing these microcalcifications and solid lumps more easily is the coned down magnification view, which magnifies an area on the mammogram. This allows a better view of what these abnormalities are and sometimes shows them to be more, or sometimes, less suspicious.

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Physician Examination

If an abnormality is seen by the radiologist, a physician well versed in breast cancer should review the mammogram, interview the patient and perform a thorough physical examination.

Sometimes, a lump corresponding to the abnormal area seen on the mammogram can be felt or other subtle signs of breast cancer can be found, and the physician can then act on these new findings. Additional tests may be ordered or a wait-and-see attitude may be adopted, depending on the degree of suspicion of the physician or the anxiety of the patient. With the wider use of screening mammography performed on a routine basis, we are now finding cancers at very early stages when neither the patient nor the physician can feel any abnormality. The tumors are often so small that the surgeon can not feel a lump even after an incision is made in the breast. Previously, this led many surgeons to remove a quadrant of the breast to make sure that the radiographic abnormality was removed.

Needle Localization Biopsy

However, in 1976, at Harvard's Beth Israel Hospital in Boston, two surgeons and a radiologist devised a way of pinpointing the abnormality to within a few millimeters, thus minimizing the amount of breast tissue being removed, if done properly.

The technique, called a needle localization biopsy, is done in two stages. A mammogram is repeated on the abnormal side with a grid or map applied over the breast. In this way, the radiologist knows that the abnormality is at a certain coordinate, say B3 or C2.

The skin is then well numbed with a local anesthetic and a needle is passed by a radiologist down through the breast, very close to or through the abnormal area. Repeat x-rays are obtained to make sure the needle is in the correct place.

If all is OK, a fine wire is passed down into the needle and the needle is removed. A dressing is applied and the patient goes to the operating room. An anesthesiologist may then take care of the patient, usually administering intravenous sedatives. A surgeon, using local anesthesia, makes a small incision, follows the wire down and removes the abnormal area.

A mammogram is taken of the tissue that is removed to make sure that the radiographic abnormality has been removed. The tissue is then sent to the pathologist for analysis.

The incision is closed, the patient goes back to her room and usually can go home within a few hours. Most people need very little pain medicine and are back at work in one or two days. The success rate is usually around 97.5%.

While sticking needles in breasts may seem intimidating, in fact, it is surprisingly well tolerated. Aside from the nipple (where needle localizations are virtually never placed), the rest of the breast is just not as sensitive to needle sticks as one would think.

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Stereotactic Core Needle Breast Biopsy

Now, however, an even easier method of biopsying mammographic abnormalities is available. A digital camera, using a microchip similar to those used in camcorders, takes a mammogram, sending the image to a computer screen in only 5 seconds. The computer calculates where the abnormality is in 3-D space almost instantaneously and tells the radiologist where to place a special biopsy needle in the breast to remove a small pencil-lead sized core of tissue. The 3-4 mm. incision, rather than a 30 mm. incision needed in the previously described surgical procedure, is closed with a strip of tape as no sutures are necessary. A bandage is applied and the patient goes home. It is truly minimally invasive, virtually painless surgery.

The procedure of stereotactic core needle biopsy is as accurate, if not more accurate than open surgical biopsy, has fewer complications and costs roughly one third to one half that of open biopsy. It is being used at over 1200 medical centers. Needle localization biopsy is available at most local hospitals.

The procedure is FDA approved and most major insurers and Medicare pay for the procedure.

I ask all my patients how difficult the process was for them. All of them tell me that the biopsy was the easy part. It was the anxiety and fear of the unknown that bothered them.

So, if your mammogram is abnormal, take heart, for 70-80% of the time it is not cancer. And, if you do need a biopsy, the procedure can be done with a minimum of pain.

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Peace of Mind

Remember, only mammography can detect a cancer before we can feel it. Routine mammography and physical exams can decrease breast cancer mortality by 30-40% in women over 40. If we can find the cancer early, we can make a significant difference in survival.

With breast cancer now occurring in one in eight women, isn't a mammogram a small price to pay for peace of mind?

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Preparation for Stereotactic Needle Breast Biopsy

Avoiding Medications
  • To decrease the risk of bleeding, certain medications should be avoided. If you are taking anticoagulants ("blood thinners", such as Coumadin, Warfarin or Heparin), aspirin or other medications for pain or arthritis (such as ibuprofen, Advil, Motrin, Naprosyn, etc.), please inform us before making an appointment for this examination. Do not take aspirin for 7 days before the biopsy or for 24 hours after the biopsy. Do not take Advil or similar drugs for three days before the biopsy. Take acetaminophen (Tylenol) instead.
  • If you are allergic to a local anesthetic medication, please inform us before making an appointment for this biopsy procedure.
What to Eat, What to Wear
  • Eat a light breakfast or lunch prior to the examination, limiting fluids.
  • Wash your breasts and underarms thoroughly with soap and water.
  • Wear loose-fitting, two-piece clothes to simplify undressing and dressing.
  • Wear a brassiere.
  • Be prepared to spend about 1-2 hours at the Mobile Biopsy Unit.

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Post Stereotactic Biopsy Instructions

  • The ice pack that was placed on top of the pressure bandage inside your brassiere is to be left on for one (1) hour following the procedure. Then, place the ice pack in your freezer and from then on wear the ice pack for ten (10) minutes per hour until bedtime.
  • If you should need medication for discomfort, take Tylenol. Do not take aspirin or ibuprofen for twenty-four (24) hours following the procedure.
  • Do not participate in any strenuous activity for twenty-four (24) hours following the procedure, e.g., tennis, lifting, etc.
  • Watch for excessive bleeding or pain. If either occurs, contact the Radiologist who performed your biopsy. Often, applying firm pressure to the site for ten (10) minutes will stop the problem.
  • You may remove the pressure dressing in 24 hours. This may or may not cause the steri-strip to come off. You may then bathe or shower.
  • If the steri-strip does not come off with the pressure bandage, remove it three (3) days after your biopsy.
  • You may cover the area with a Band-aid if you so desire.

Biopsy Results

  • Please contact the physician who ordered the stereotactic biopsy if you have not heard of the results in four (4) working days. The pathologist analyzing the tissue should have reported the results to your physician by then.

Follow-up Mammography

  • It is vital to have a follow-up mammogram performed in six months on the biopsied breast. You should also have bilateral mammograms performed in 12 , 24 and 36 months in follow-up

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MoBx is pleased to have been of service to you.

For more information about our service, e-mail us at info@ums-sua.com..

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