THE BIOPSIES

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Here are several breast images pertinent to my procedures and breast imaging with links of thousands of photos from websites of hospitals across the country very comparable to Kansas University Medical Center, KS. None of the images herein are my copyright nor my property. And as fascinated by photos of our anatomy, I can’t decipher these images any more than a fifteen year old. But it helps to see something in B&W, they’re not just words any more.

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After the first consultation, I felt very logical and researched photos and medical journals online, discussed the issue like I was remodeling the basement. I was not in denial, just didn’t feel real. My husband agreed with my decision and the first biopsy appointment was set for the day after Christmas.

By design, biopsies are as least invasive as possible, especially to sample carcinoma tissues. It is a meticulously precise extraction of cell removal for analysis. It is in essence surgery. To me it was a necessary evil, nevertheless the upcoming procedures made me very nervous.

I had orders not to eat, but that was no problem because I lost my appetite. To top it off I had fought a mild migraine on Christmas Day prior to the exam … Just nerves …  and memories of my mother’s breast treatment. But knowing she wasn’t in pain eased mine, now I simply missed my sweet mother who had had the patience of a saint … my guardian angel now.

Looking in the mirror while brushing my hair, I noticed my hand was shaky. Dammit. My stomach was empty but I hoped I didn’t throw up with the slight queasiness in my tummy. I whispered grimly, “okay Mom, I need you a little today so can you please do your angel thing for me?”  Twenty-nine years ago that day she died, tainting my holiday cheer for years — memories of her were strong — I needed her calm.  

my fears began to feel real     

All of a sudden I was put through rigorous tests to definitively, meticulously prove and disprove the stage of my breast cancer. I had the initial mammogram late October at Diagnostic Imaging in Independence. But we all know every hospital must rely on their own resources so yet another mammogram was done at KUMC* in Overland Park. Then an Ultrasound was done. Yes, I was surprised, but understood how it worked, the very same as for a fetal exam. I didn’t know the difficulties of having ‘dense’ breasts. I did not know there was such a thing, what problems arose with mammogram images nor that I even had such a problem, till this. Hmmmm… an Ultrasound and MRI for dense breasts.     

 

Radiologists Id’d another spot on my right breast they were intent to decipher. It was diagnosed necessary to be marked for further eval and testing. I asked, it was no bigger than the tip of a sewing needle. Incredible. Detection of a spot so miniscule, a single cell, and the tests for it boggled my mind. Dr. Jew needed two more biopsies for an accurate pathology analysis, a biopsy called a fine-needle aspiration biopsy (FNAB) and the ‘Vacuum-assisted biopsy’ also called a (‘core needle’ biopsy).

I kinda lost track of what test was called what and what each was for. Either result would show the exact size and dimension of my tumor, thus indicating the procedure Dr. Jew would perform and the specified protocol. We had discussed my options to best cure me from ‘Ductal Invasive Carcinoma‘, Stage 2. Breast cancer is labeled Stage 0 – 4. Yes, it was all very complex information for my layman brain to register. Mostly I just went with the flow trusting Dr. Jew with all the testing that followed, and that necessitated constant communication between Trisha and me. I had already sensed Dr. Jew’s intense conscientiousness so I zipped my lip of any complaints or anxiety. I didn’t have any of her. Getting a cancer diagnosis, I knew they knew anxiety was a given anyway and tried to prepare for the worst, not a real believer in Murphy’s Law — I’m a real optimist. But this was breast cancer. Time to get serious and kick some real ass. But how??

A stereotactic breast biopsy is done after a mammogram shows suspicious thickening (cell or other issues need to be addressed. In my case, it wasexcessive calcification cells possibly turned malignant. In plain talk: the milk ducts and lobules show bright white on the mammogram slides that indicates a cancer tumor.

My first biopsy was a stereotactic breast biopsy , done while sitting next to the machine, set up the same as for a mammogram. They also perform this with the patient lying down. This process was not meant to be painful so I didn’t expect any. I sat in front of the machine with the half-gown draped over my shoulders.

Two nurses hovered around me, secured my left breast tightly into the plastic apparatus, pressed onto the base. They urged me “don’t move” as the first technician poked my left breast with the core vacuum needle. Instantly I felt like I was stabbed by a dagger!  Excruciating pain!  I gasped, got dizzy and nearly passed out as the nurses scrambled giving me wake-up scents. Obviously they hadn’t numbed the biopsy site with enough local anesthetic. He inserted the metal marker for the MRI. They rushed to finish. The nurses took my vitals and got me talking as I began to breathe normal again as tears ran down my face. In the midst of them hovering over me the technician left with his results. I vaguely remember him. I felt dazed for a few minutes.

When I checked out I complained about him — he was not going to touch me again or I’d knock him on his ass. I think the staff believed me but there was no more need to worry anyway. It was done. I drove home unnerved yet relieved that test was over. From then on, to hell with not complaining!  

The next week Christmas was over and the kids had calmed down and everyone had resumed their daily activities. I got a call from Trisha. They needed an MRI to confirm the exact tumor size and shape. I protested when she told me it’s the machine that’s shaped like a tomb. I’m claustrophobic but Trisha, reassured me it is painless, just very noisy. There was no talking her out of an MRI that Dr. Jew ordered. The MRI was set.

Trisha gave me instructions to prepare. Since the next biopsy required more local anesthesia than the first, I’d be unable to drive after this one, my husband accompanied me. Besides, next to the patient reception/waiting room was a free breakfast — a man’s gotta eat. Then he could relax in a lounge chair in the reception/waiting area. They ushered me to the lab.

Once in the MRI prep area, the head nurse, a stout kindly woman, explained the noise is really sound waves aimed at the tumor in dozens of frames of photos to produce 3D images. It’s the only way they can pinpoint the cancer cells without surgery. I thought why warn me about sound waves?

The funny thing was the nurse scrambling to find pliers to help me remove my belly button ring. Always kept discreet, my husband saw my tiny jewelry as a tidbit of sensual allure. I hadn’t removed it in 20 years, so that in itself was a challenge. I’d never removed my 2nd set of earrings my daughter gave me as a birthday gift either. But the nurse-lady warned me the highly magnetic machine would literally grab and rip out any jewelry so all earrings and my tiny tummy jewelry had to go.  (Refer to the MRI machine image and you’ll see how close that magnetic field is to your body so it’s no wonder it has the power to yank out any jewelry.)

Finally prepped with an IV, gown and warm socks, the nurse wheeled me into the room. Getting onto the ‘table’ I panicked, but the nurse talked me through it, especially with their tight schedule it meant that if I ordered stop, quit the test, the next available date was late February. That would not sit well with Dr. Jew, convinced me to suck up and get it done NOW. Again I nervously informed the attendants I’m seriously claustrophobic, so the nurse gave me a panic button. I wrapped my hand around it without holding the button itself. My heart pounded out of my chest — I was very prepared to panic inside the machine. (I didn’t look in it.) One tech said to hold my arms and hands still but I could flex my fingers okay …

My nurse spoke softly and very reassuring, made me very comfortable lying face down on pillows with special attention for me to lay ergonomically neutral, my arms overhead. They foresaw every need, every comfort. She wrapped warm blankets over my legs so I relaxed — I wasn’t faking it. My face was buried in the covers like an infant in a 20° below  Iowa wind. She leaned into my space and reminded me not to move or flex my muscles in either arms or legs once I rolled inside the machine. I simply nodded.

The MRI is similar to a chiropractor’s table, with two openings for my breasts to hang down through. My exam was using the Sentinelle Vanguard Breast MRI table or at least a close facsimile. Each technician urged me, reminding me again not to move anything. They numbed and fastened each breast so neither would move even a micron. Me moving would disrupt the images and we’d be stuck with the process all over again. I made myself go into ‘yoga’ mode so I would not inadvertently move. They put headphones on me with 80’s music. My boobs were both in super-lockdown.breast_mri_patient_275x160

I barely heard the headphones music but it was a comfort to hear in between the MRI hammering noise that permeated my head. Like being stuck inside a jet’s turbos!  Loud … a jackhammer noise makes ya wanna hit something.

Forty long minutes later to the second, the technician shut down the noisy MRI machine. My comatose pose was not enough for forty minutes. I felt fidgety inside and my left shoulder and arm muscles cramped up held over my head strapped down for so long, meanwhile the nurse massaged my shoulders — felt so good. She massaged and talked me through it like a live, gentle angel. I figure she gave my mother some much needed assistance.

After it was done, they slid me out of the round tunnel-thing and the nurse removed all the blankets from me. I felt wobbly and a bit weak from the fighter-jet-hammering around my head and nothing on my stomach. I told the nurse I imagined I shot at it with a machine gun and she nodded, said that was a good thing to imagine!  She told me some service guys have to be sedated, not able to tolerate the hammering noise too similar to enemy gunfire. I could sympathize! She said I did fine! They got lots of excellent pictures.

brstcanc
(A) normal breast and (B) cancer

Normal breast tissue showing:

  1. The premammary zone (skin and overlying breast fat)
  2. The mammary zone (fibroglandular tissue)
  3. The retro-mammary zone (predominantly fat and the muscles of the chest wall)

RESEARCH SHOWS

  • Early detection can increase breast cancer survival.
  • Finding cancers when they are small saves lives.
  • More than 40% of women have dense-breast tissue.
  • Automated Whole-Breast Ultrasound (AWBUS), in addition to mammography, may find as many as 100% more cancers in women with dense breasts than can be found by mammography alone.
     FATTY BREASTS  DENSE BREASTS  ULTRASOUND
Spotting tiny cancers in the mammogram of a fatty breast is easier because cancer shows up white on dark fatty-breast tissue, as shown here. Cancers are harder to find in the mammogram of a dense breast because both cancer and dense-breast tissue show up white. With ultrasound, cancers usually appear

dark against the white background of dense-breast tissue, making the cancer more visible. The image above shows a 6 mm cancer which was not detected on the mammogram.

mri-326776 this ultrasound image is what cancer images looks like.

(Below) is a ‘normal’ image. I was amazed.breast-normal

And then round three …

I mentioned I needed a second biopsy of the tiniest spec the size of the point of a sewing needle, they couldn’t identify on the right breast… Another mammogram, more 3D photos, another sonogram. I felt like a guinea pig by then. Although, I was glad they were so meticulous and I was impressed by their coordination of job duties within their tight schedules. Their teamwork was admirable. The next week Trisha called several times to coordinate times and dates of tests in sequence in preparation for the scheduled mastectomy. Coming up fast. I didn’t envy her, her job.  

My third biopsy was scheduled for New Year’s Eve day, 6:30 a.m. That MRI was the same tomb machine but not as excruciatingly loud nor as long in duration. Prepping me took over an hour but at the technician gave me a mild sedative, consequently I nearly fell asleep. They kept telling me I was doing fine, not to move — weird thing being allowed to breathe normally but can’t move your legs, toes, hands, or body, so not sure how breathing works out to acquire all the photos of my breast.  

The doctor performing the biopsy was an attending physician I guess, learning hands-on complex, delicate procedures.

I caught bits of how-to-do-this-why-to-do-that by another authoritative voice, a woman lead doctor. Again my head was buried face down inside warm blankets. I never saw her. I heard and felt the pressure of the suction and thanked him the needle didn’t hurt this time. He asked that I let him know if I felt any pain. But I did not. Again I complained to everyone of the other guy who ineptly poked me, I’m sure they knew yet made no difference. When finished it was the same rigamarole to get me off the table, check my vitals and release me to go home. The sedative lasted mere minutes after the MRI biopsy. I felt fine.

I couldn’t eat the night before so I was starving! Ed took me out for a luscious, hot pork chops and pancakes breakfast at IHOP and strong hot coffee. Mmmm.

 

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