What To Expect During A Core Needle Biopsy

This is a throwback post from my caringbridge.org site posting of Wednesday, March 24, 2010, posted about a month after my lumpectomy. After the lumpectomy, my breast surgeon had an MRI done, and a 2nd very small lump in a hard to reach spot in my lower left breast was found. Because of the unusual placement of the 2nd lump, I needed to have a procedure called a core needle biopsy.

I’ve never shared my experience about my core needle biopsy procedure in my blog, before this. I didn’t want to scare anyone else off who might have to have one done, but I know that there will be others who will have to have this procedure so I think it’s worth posting about my experience in the hopes that this could help prepare them. I like to know what I’m facing so that I can prepare myself both mentally and physically; if you do too, then read this post. If your coping mechanism is that you’d rather not know what’s in front of you, then don’t! Everyone has their own way of getting through a crisis, you do what works for you!

IMPORTANT TO NOTE: I had the core needle biopsy a few weeks after my lumpectomy surgery. Since my breast had recently been operated on, I was still experiencing quite a bit of tenderness and soreness in it when I had the core needle biopsy done. Keep in mind that this contributed to why my core needle biopsy was more uncomfortable and in fact painful, than it would be for most women. Also, I’ve since spoken with another woman who had one done and she said it wasn’t painful at all. She didn’t have dense breasts, so perhaps the density of your breasts may also have something to do with the level of discomfort you’ll experience if you have this procedure. With that in mind, here’s what I had to say on my caringbridge.org page, the day after I had the core needle biopsy.

March 24, 2010

Wow. What a crazy experience the core needle biopsy was. It was worse for me than the lumpectomy surgery. I think it was even scarier for me because I was wide awake and so completely aware of what they were doing the whole time. I don’t want to scare anyone who may someday have to have this procedure, but this was one crazy, horrible, barbaric procedure! And that’s being kind.

I went into this procedure rather unaware. I had no idea it would be painful or how frightening it would be, so if you know how to prepare going in, perhaps it would be easier for you. Or maybe you could take a xanax or something to calm you down. I know I wish I had. I also wish I had known that I should have had someone go with me. I originally thought I could do all this on my own and at this point, I still wasn’t bringing someone with me to every procedure. I wish I had for this one.

The procedure was done in the hospital by a specialist. After spending some time in the waiting room (it seems that there’s always a wait for these procedures), I went into a room and was told to remove my top and bra, and then sit facing forward in a reclining chair. Directly next to me on my right was a radiologist operating an ultrasound machine so that she could help locate exactly where the very tiny lump was, to help guide the doctor during the procedure.

Once the spot was found on the ultrasound, the doctor came over to my left side side and inserted the hollow core needle into my breast so that he could remove several thin, cylindrical shaped pieces of tissue from the very tiny tumor. The needle is hollow and as the picture shows, looks a lot like a gun – kind of scary. Well that should have warned me, because it’s way thicker than a normal needle and of course, that much harder to insert, but I just wasn’t thinking straight during all these early procedures and didn’t realize how tough this was going to be.  I was often so focused on getting the procedure scheduled, that I would often forget about what they were actually going to do, during it.

The doctor did about 6 passes with the needle. In between he would go to a table and remove the tissue specimens from the needle, and then come back to my side to remove more. I had to sit perfectly still throughout, in an awkward position, to ensure that the ultrasound would show where the hard to find lump was.

Truth: It was painful. My breast was already quite sore from the recent lumpectomy and the lump was in a very difficult to reach spot, and I was really nervous. At first, when he left my side after the first pass, I thought he was done and asked the radiologist if the procedure was done but she said, no, that the doctor would need to remove several more specimens in order to have enough to do a biopsy. That’s when I started to slowly but surely panic.

If you’ve ever had a tooth pulled, I would compare it to that; it’s similar to the pressure when the dentist is pulling a tooth out, but imagine having a tooth pulled out of your breast. The doctor had to push very hard to insert the hollow needle, and then a gun sound went off as the needle went into the small lump in my breast to remove the tissue. And because the doctor’s hand is being guided by the ultrasound, it was important for me not to move at all, and to stay completely stationary so that I wouldn’t interfere with his ability to find the exact spot.

It was honestly more terrifying than the surgery, more painful than any other procedure I’d had done to date. I think it was about 20-30 minutes from beginning to end but it was so frightening that it seemed longer. I was scared and frozen in place throughout the entire process.

One of the nurses in the room could see how scared I was and came over to hold my hand every time the doctor would begin the insertion process. I didn’t even ask her, she just came over on her own and gently took my hand during each subsequent tissue removal.

After they finally removed all of the specimens, they put a little tiny titanium “seed” into the spot where the tumor was and then the doctor told me they had to do a mammography to see if it was in the right spot so that in the event that the lump is benign, they’ll be able to identify it in the future on mammograms or MRI’s or ultrasounds.

When the titanium seed was in place and they told me that the procedure was finally done, I just broke down and cried more than I’ve cried since this whole process began. I was really sobbing, with tears pouring down my face, snorg pouring out of my nose, shoulders shaking, my hands over my face as I wailed out loud. I couldn’t stop for about 10 minutes, it was very unlike me, as I’d never let it all out like that during a procedure before.

Throughout all my crying, the nurse and radiologist kept patting my knees and feet and holding my hand and saying, “You’ve been through a lot, it’s a lot to deal with,” and being so sweet and kind and compassionate while I just kept sobbing.

Then they even held my arm as they walked me to the mammography room and then whispered to the mammography radiologist to be careful with me, because clearly I was a wreck. She was also really nice, and actually didn’t squeeze as hard as they usually do, and let me tell her when she needed to stop squeezing the paddles, which is not what they do during a regular mammogram from my experience.

Once the mammogram ensured that the seed was in the right spot and visible, they gave me little, tiny ice packs to put inside my bra, to help reduce the pain and swelling on my breast. The cool mini ice packs felt good and helped numb the area, which was so tender. By this time, I was starting to feel a lot better as I knew the worst was behind me, but the staff had apparently decided they needed to keep an eye on me, and stuck by my side until I got dressed and left the hospital.

And then, when I got into my car in the hospital parking lot, I realized that the procedure had taken so long that I had to go straight to a 3 hour client meeting a full hours ride away!

What was I thinking?! About halfway there, I realized I was just about ready to fall asleep I was so exhausted, but in some ways I think it was helpful for me to just go back to work so I couldn’t spend too much time dwelling on the crazy procedure or the test results which won’t be ready for at least another 3-5 days.

I am so damn glad that this procedure is over. If I ever have to do that again, I swear, I will make them put me out before I’ll stay awake through that again. And I had 2 children through natural childbirth with no epidural and no drugs and my son was 9 lbs. 4 oz.! So, it’s not that I’m a wimp about pain.

Here’s what I would recommend anyone going through this procedure keep in mind to help get through a core needle biopsy:

• Wear something comfortable; I would recommend a loose fitting top.
• Take 3 Motrin about 30 minutes before the procedure (check with the hospital and ask if it’s okay to do this prior, just to be sure) to help reduce the pain and possible swelling.
• Bring someone with you and don’t drive yourself home alone. This is not the time to be brave, have someone there to help you get through this.
• Before the procedure, ask the hospital if they will provide you with anything to calm you down during the biopsy, like xanax or valium (another reason why it’s important to have someone drive you home).
• Review the procedure in detail online and know that it will take about 20-30 minutes, so that you’ll be prepared to sit still and stay as immobile as possible throughout the entire procedure.
• Know that after the biopsy they will do another mammogram to ensure that the seeds are in place to help identify the tumor area if another surgery is needed.
• Be aware that afterwards, they will provide you with ice packs to soothe the area, and that they’re small enough to slip inside your bra without being visible. They really helped.

I hope that you don’t ever need to go through this procedure but if you do, please consider the tips above to help you through.