Healthy Living

What to expect: Reality not as hard as the waiting and worrying with breast biopsies

A 3D stereotactic biopsy table is seen at the Mercy Women’s Center at Mercy Medical Center in Cedar Rapids on Monday, Oct. 22, 2018. The center deploys 3D imaging technology to detect irregular breast tissue, including a 3D stereotactic biopsy table. (Rebecca F. Miller/The Gazette)
A 3D stereotactic biopsy table is seen at the Mercy Women’s Center at Mercy Medical Center in Cedar Rapids on Monday, Oct. 22, 2018. The center deploys 3D imaging technology to detect irregular breast tissue, including a 3D stereotactic biopsy table. (Rebecca F. Miller/The Gazette)
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The worst year of Lori Stevenson’s life saved her life.

January 2016 began with a mammogram and quickly progressed to a second mammogram and an ultrasound at that same appointment, then an ultrasound breast biopsy a couple days later, followed by a cancer diagnosis and further testing, including a breast MRI to determine the size of the mass in her right breast.

By February, she started 12-weeks followed by eight-weeks of chemotherapy to shrink the tumor. In November 2016, she had a lumpectomy, followed by six weeks of daily radiation to treat her stage 2 triple-negative breast cancer.

That’s a lot to process in a year.

The waiting time was “super emotional,” said Stevenson, now 48, of Cedar Rapids. “Even though it happened fairly quickly, it was still that waiting.”

Women who have had mammograms know what to expect with that uncomfortable test, but anticipating a biopsy takes the fear factor to a whole different level.

BREAST BIOPSIES

One breast biopsy option involves lying face-down on a prone table with a cutout section, so the breast descends through that hole. The table rises, and the doctor and the procedural equipment slide underneath to access the breast. Guided by a mammography to show the site, the radiologist removes core samples of suspicious tissue for testing. The Women’s Center at Mercy Medical Center in Cedar Rapids has a new stereotactic prone system that offers 2D and 3D imaging-guided biopsies in the same unit.

Because Stevenson’s 2-centimeter tumor in the right breast was near the chest wall and could be seen via ultrasound, she could lie on her back for her initial needle biopsy.

Core samples a little thicker than a pen tip are vacuumed through a small needle and into a trough, then delivered into a catchment basket and sent off for analysis. Multiple samples can be gathered from one needle placement, radiologist Dr. Arnold Honick said.

Afterward, a small clip is placed to mark the tumor’s location. Clips are placed to guide doctors to specific sites for follow-up surgeries or subsequent mammograms.

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Another option keeps the patient sitting up, wheeled up to a mammogram machine. That’s the kind I had a year ago, to biopsy calcifications in my right breast. It’s especially useful for people who can’t or don’t want to lie on their stomach for up to an hour.

“It’s the same technique, you’re either lying down or not,” said Honick, who did my procedure at St. Luke’s Breast and Bone Health, but was at Mercy Women’s Center for this recent interview.

He was standing by Mercy’s newest prone stereotactic biopsy table, which offers the latest in 3D imaging to show the doctor the site and depth for placing the needle. Stereotactic uses trigonometry to find two angles to guide the needle to the biopsy site, while 3D uses images to visually “slice” down to the site, he said.

“You can target your area of concern either way, but with 3D imaging, there are a variety of things more beneficial than stereotactic,” he said. “The most common is twofold. Sometimes there’s a mass in the breast — or what looks like a mass — that you can’t see by ultrasound. So it allows you to march down to where that mass is and accurately place the needle.

“And then there’s areas where the tissue looks distorted, drawn in, like a scar in the breast, but there’s never been an injury, so that could sometimes be a sign of a benign thing or breast cancer,” he said. “Sometimes you can’t see that by ultrasound, so it allows you to see that distortion with the 3D imaging. So that’s why the combination of 3D and stereotactic is beneficial with this.

“The stereotactic imaging is fairly easily done for calcifications, because you can see them whether you use 3D or not. Both provide an accurate way to place the needle in the right place,” he said.

“3D can be used for all the things, but it’s better for using it for masses you can’t see by ultrasound or areas of distortion, to accurately place the needle.”

After her first round of chemo, Stevenson’s tumor was gone. So the day of her lumpectomy, she had to lie on her stomach on the stereotactic prone table so the medical team could find the clip placed at the tumor site and insert a wire so the doctor would know where to remove a golf-ball size section of breast tissue.

Nothing about the biopsy hurts, beyond the quick sting of the local anesthetic.

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“The numbing shot was one of those things where you work it up to be more than what you think, because it does go right at the nipple area,” Stevenson said. She thought she’d be “screaming and screeching,” but instead felt a little burning “as with most numbing medications,” she said. “I don’t recall feeling the procedure at all.”

To help allay fears for anyone else receiving the dreaded recommendation for a biopsy, Honick noted the majority of breast biopsies come back benign.

“It’s done because you can’t tell the difference (in tissue) sometimes,” he said. “Number two, local anesthesia works well for most people. And if it’s administered correctly, it does just fine. And I would say the majority of the people who have breast biopsies feel that is not as bad as they anticipated it to be.”

I was one of the lucky ones to hear “benign,” but still felt like I could pass out when Honick called with the results. “Don’t do that,” I remember him saying.

Stevenson wasn’t so lucky — except that her aggressive form of cancer was discovered early enough to treat and increase her odds for a good outcome.

“I had a gut feeling from the call back, that although they were going to take all the steps to double-check everything, I just had a feeling — but it’s still very emotional,” she said.

“And when I got the call from my family doctor, I also knew, because otherwise, someone from the Women’s Center would have told me ‘all clear.’ So when I got the call from my family doctor’s office to come in that day, I didn’t know the extent, but I just knew it was going to be a cancer diagnosis.”

Her husband was by her side for both the biopsy and the delivery of the news, she said, tearing up at the memory. “It was so helpful to have that.”

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She also derived strength from social media support, as well as her friends who “were waiting on pins and needles” for the news.

Telling her three sons was the hardest part.

The oldest boys, now 25 and 24, cried. Her youngest son, soon to be 14, was 11 or 12 at the time and “took it so well,” she said. “He became the champion for us.” He discovered a video game made by parents whose child had died of cancer. Titled “Fight the Dragon,” Stevenson’s rallying cry then became “Fight the dragon, stay afloat.”

“It was a tough year and two weeks,” she said, but she was able to keep her full-time job at PMX Industries. She scaled back to part-time, working largely from home, because she was weak from the chemo, which caused nausea and dehydration. She also lost her hair and endured radiation burns.

The fight was for her children. “There’s no way I was going to orphan them,” she said.

And with a 49th birthday quickly approaching, she’s just “thankful to add the years.”

She didn’t spend her days asking “why me” or “what if.”

“I just have to move forward,” she said.

“I had a co-worker who put it pretty eloquently, too, when I talked about it being disappointing that I had to have all three forms of treatment (surgery, chemo and radiation) and that it took a full year.

“She said, ‘Well, look at it this way: It could have been the last year of your life, and now it’s just the worst year of your life.’”

l Comments: (319) 368-8508; diana.nollen@thegazette.com

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