Biopsy Choices

I am 44 years old and have had 3 previous breast biopsies (removal of entire lumps) on both breasts.  Each time the results came back Fibroadenoma's. I had my yearly ultrasound in Jan and a nonpalpable lump measuring 3cm was found in my left breast at 12oclock.  I was told to come back in 6 months.  On my followup visit in July the lump measured 4cm.  The radiologist said the size could have been missed measured in Jan. But that I should have it biopsied.  My question is should I have a core needle biopsy this time or stick with surgery.  My surgeon recommends surgery.  He said that if I do a core needle biopsy, I will most likely need to have a followup ultrasound in 6 months. And if there is any change it would have to be removed anyways.  Is that true?  My surgeon believes this lump is also a fibroadenoma.  I have very dense breast.  Is a core needle biopsy painful?

[CCF-RN,MSN-rf]

Dear kyh44:  Fibroadenomas are non-malignant (benign) lumps that feel smooth, and round. They can vary from very small to quite large (5cm). Fibroadenomas are usually distinct on a mammogram and ultrasound. Most believe that they grow over a 12 month period and then remain stable. They are most common in women in their teens and early 20's but can happen at any age - although they usually don't occur much after menopause (hormone therapy tricks your body into believing it is premenopausal). If the size is stable and the fibroadenoma is not bothering the woman - there may be no reason to remove it.  Another reason to remove it would be to be certain it is a fibroadenoma.  If there is doubt - or if it continues to grow, removal may also be recommended.  If there is any concern that the lump is cancerous, a core biopsy may help to determine the diagnosis which would be helpful in determining the type of surgery that needs to be done.  Since institutions vary in their experience with the different approaches, it may be worthwhile to discuss biopsy/removal options with your surgeon to determine the best approach for you.

[Twocapes]

Done correctly, core needle biopsies should not be painful although everyone's "pain threshold" is different.  3 to 4 cm is quite a jump and also a good size lump.  I have had both types of biopsies (surgical and core needle) and I would opt to have that size lesion removed.  It could mask something else and also there is a very slim chance that part of the lump could be cancer and missed by the core needle.  Keep us updated.