Needle Location Biopsy

[SnowWoman]

Am scheduled for needle location of mass by mammography and then to go to ultrasound to see if that location corresponds with what they found on the ultrasound.  If not, they'll insert another wire at that location.  Then for an open biopsy of the sites.

My concern is that the needle loc is scheduled for 8:15 am and the surgery is not until mid-afternoon.  What is the possibility of the wire moving or being displaced in between?  I realize there is a hook on the end so it shouldn't be too much of a problem but I would hate to go thru the surgery and have them not get the right tissue because it did.  Also, how long should the local anesthetic they use for the needle loc last?  Am I going to be miserable waiting to get into surgery?  If these aren't real issues, is there any reason that I can't go home while waiting the 5+ hours for surgery?

I'm quite upset by the scheduling of all this -- is it common to have such a long wait between the needle loc and surgery?

[CCF-RN,MSN-JS]

Dear Snow Woman, The timing between the needle localization and the surgery is a function of the facility in which you are having the procedure done.  Because the parts of the procedure are done in different departments (localization in radiolog and surgery in the operating room) and the need to coordinate schedules varies.  The wire that is left in place is very fine, and should not cause pain.  The radiologist does all possible to make sure that there isn't movement of the wire (the hook, taping markers to the wire etc.) you will also be instructed to do as little as possible between the time of localization and surgery to hopefully not dislodge the wire - one reason for having you wait in the facility rather than dressing and going home to wait.  Talk with the staff at the facility where you are going to see if there is any way of rearranging the timing so there isn't so much time in between procedures.

[surgeon]

The wire won't hurt while it's in, even after the local wears off. The timing is less than optimal, all right; but typically they bandage and protect the wire in such a way that it should be ok. Probably the best thing is to not get too frisky in the interim: going home might subject you to more moving around, I'd think. I suppose part of the long time was to allow for another localization if necessary.

[nurse12hr]

I had the same type of thing done.  They did bandage up where the wire was quite tightly, and I was cautioned not to touch it or disturb it.  Had the needle loc about 9a, surgery at 2p.  Didn't go anywhere in between.

good luck to you.

[ritavv]

I had needle localization very early in the morning and then was sent for the sentinel node biopsy injection(radioactive tracer) prior to surgery.  Before they did the scan, they had me sitting in the hallway moving my arm like a propeller.  ... all this with the needle sticking out of me.  The said that the movement helps the tracer get to the nodes and they have more success that way.  I didn't have my surgery until about 5 hours after my needle localization.  It was not that big of a deal except for the stress of the day.

[SnowWoman]

Just went for my Pre-op appointment and the nurse thought that they might actually be getting me in for surgery an hour or so sooner -- every bit would help -- we'll see.  Besides just the frustration and stress of spending the day waiting, I'm concerned about having to "waste" half a day of leave time.  Used up most of my leave time taking care of my dying Mom earlier this year so I have little available for dealing with this if it turns into something.  Right now that's probably a bigger stress to me than the surgery.

How long should the needle localization take?  They're talking up to 3 hours.  From what I've read it seems if they know what they're doing it really shouldn't take that long although I realize there can be circumstances.  How many times I should let them poke me trying to find the right place before questioning if they know what they're doing?

[Bet63]

I had needle localization prior to excisional biopsy also. The actual needle placement only took a few seconds. (I had no local) The longest part was the mammo to find the calcifications and then not moving while they did another mammo to check location of the needle. After the needle was in they covered with a big styrofoam container so it wouldn't be moved and wouldn't rub against my gown. It worked well. I think the whole location procedure only took about 20 - 30 minutes and I had no pain where they inserted the needle/wire.  

Good luck to you! I know the waiting is terrible but if you try to think positive you should be ok. Bring something to read while you wait. You won't have to move much and your mind will be occupied somewhat.

Bet

[SCMom]

I also had a needle loc prior to excisional biopsy. I went in at 9, and had no local or anything to numb the skin for the needle loc. The wire felt like a stick when they draw blood, and that was it. It does take time for them to do mammos to see if the wire is in the correct place. They do a mammo first, mark the coordinates with a marker on your skin, and then put in the wire and do more mammos. You have to stay still and in compression during this. They may pull back slightly on the wire to reposition  it. Then more mammos. The mammos develop right there, sort of like a 1-hour photo at the drugstore, only faster!(Takes about 5 min for the films to come out.) I have never heard of them poking around several times with the needle. A doctor did the procedure. My wire was taped, I dressed completely, and walked across the hospital campus to surgery. It was about 1/4 mile. The wire felt about like an underwire bra "poking" me. Nothing close to miserable! I hope everything goes well for you!

[nurse12hr]

Mine did not take long, either.  Perhaps 15 min total.  One stick, and several mammo views.  

I do think they gave me a bit of local, and it was still fairly painful (but I am an avowed wimp).

[SnowWoman]

Thanks for the info.  I'm hoping for the best and hope everything goes smoothly.  I suppose they mostly try to prepare for the worst case (3 hours) but I'd prefer to deal with problems as they happen not anticipate things that may never be.  I'll let you know how it goes.

[SnowWoman]

Well, here's how it went.  I showed up at the Imaging Center a little after 8 am.  They did another mammo shot -- this time at 90 degrees.  There was a problem in that the lesion is (was) deep in the breast against the chest wall (from what I understand, not a good sign) so they could only see it in the side view not the front view.  They tried one more expanded front view and still couldn't see it.  With only one view they couldn't triangulate the position for inserting the needle so the radiologist decided to reverse things and we went across the road and down the way to the hospital and ultrasound.  

When I got there with the mammo. tech., they were having a conference in the hall about how to go about this. (I noticed one of the ultrasound techs was holding her breast.)  After some shuffling things around, they did the ultrasound but this time they found the lesion at 2:00 on the breast rather than 3:00 and 8 cm from the nipple rather than 6 cm (hmmm???).  Anyway, they decided it was the right thing and set up for inserting the wire.  The most painful part was doing the local and when they put pressure on the lump with the ultrasound wand.  It was interesting watching on the screen what was happening.  Once the radiologist had the needle in, he put in a drop of blue die as a marker and then inserted the wire.  He tried to push the needle into the mass but said it was too hard (another thing that I understand is not a good sign).

They wrapped everything up and we went back down the way and across the road to the Imaging Center to do 2 more mammos to see if it looked like this mass was the same as what they saw there.  They seemed to be happy about how things looked so didn't do anymore.  This all took until 10:45 -- about 2.5 hours.

Then I went back across the road to the hospital and they checked me into a room.  Unfortunately, instead of being early for the surgery they were late (what I really had expected).  Got in for surgery about 3pm.  They used local anesthesia and sedation and I don't remember anything since shortly after I got to the operating room.  I came back around when they were moving me to recovery.  First thing I had to say was: "Thought it wasn't supposed to hurt with the local."  They gave me a muscle relaxer (IV & IM) and when that didn't do the trick they gave me Demerol and sent me back to my room about 4:30.  Finally got to head home about 5:15 so it was a long day.  

Really haven't had too much pain since -- took some Vicoden last night but nothing yet this morning.  Guess I won't know anything more until my appt. next Monday with the surgeon.  Thanks for all the encouragement passed my way.

[nurse12hr]

Hi
I am glad it is over with.  Waiting for results is a bummer, though.  
I found out my results sort of accidentally.  The day after my biopsy, I ran into my doc in the corridor of the hosp (I am a nurse).  He turned white as a sheet when he saw me, and dropped all the charts he was carrying.  He was clearly unnerved to see me unexpectedly like that.  I asked him cheerfully if he had heard anything about my biopsy, and he practically ran away, stuttering "wwwwell, I'll see you in the office next week and we can talk then...".  He literally left charts on the floor and RAN.
I went into the bathroom and threw up.  I knew.  

But now, 10 years later, it is all in perspective for me.  Deal with things one day at a time, and know that we are all rooting for you.  
-***@****-
if you ever want to talk.

[SpeechLady]

Dear Snow,
I had a biopsy on Wednesday (my 3rd) and am, like you, on pins and needles awaiting the results on Monday or Tuesday. It's hard to wait but thought you might like to know you are not alone in waiting. Let's pray the results bring good reports to both of us. Until then - hang in there!

[SnowWoman]

I'm excited that I get to take off the dressing and take a real shower tonight -- yoohoo!!  Am pleased in that there doesn't seem to be much bruising.  When I had my other surgeries (20 years ago) I was black & blue from my breast bone to my back and from my collar bone to the bottom of my ribs.

What's kind of strange is that I caught myself holding my breast the other day and then realized it was the wrong one.  Don't know if it's sympathy pain or phantom pain from the prior surgery or if there's another reason that one is aching.

Let us know how things turn out for you next week.  Hope all is well.

Janet

[SnowWoman]

Got the pathology report today and it's good news.  The main lesion was fibroadenoma ("an encapsulated, 1.0 cm gray-white lesion").  I'm quite pleased (although sore -- they took out a mass of 6.0 x 3.0 x 2.0 cm thru a 3" incision) and a bit confused since it doesn't seem like the norm for such in that I thought these were mainly found in women in their 20's and early 30's.  Maybe it's just that I'm still young at breast.  Could be that it's been there awhile and been missed on previous mammograms -- hmmmm.  Also it was pretty much fixed in place when most descriptions of fibroadenomas say they tend to be somewhat mobile.  Just goes to show you why we go through the trouble and pain of the biopsy so we can know for sure.

Thanks for all the good thoughts and encouragement.  I do a follow up in six months and hopefully back to norm after that.

[SpeechLady]

Dear SnowWoman,
HOORAY! My news was the BEST! My biopsy did not indicate a return of cnacer - just fibrocystic changes and scar tissue from the last biopsy! Am praying your news was as great!
Andrea - SpeechLady

[SpeechLady]

Whoops - didn't read your results before sending my last message. I am so happy the biopsy turned out well for you too! A lucky time for both of us!!!! Congrats!
SpeechLady

[SnowWoman]

Glad to hear your good news.  Hopefully your life can go on in peace now.  This was sooo different than my last experience with benign breast problems that I was convinced there was more to it.  Thank goodness there wasn't.