sonogram biopsy

[ellagurry]

A couple of weeks ago, I noticed a lump on my breast about the size of a chestnut. I had a mammogram & sonogram yesterday. They both showed a lump that is approximately 3 cm in size on the upper right quadrant of my right breast.  
  I had a mammogram 3 years ago that had no sign of any problems. I'm 45, nonsmoker, breast fed my 2 kids, and have no history of cancer in my family, although my mother & sister have a history of noncancerous fibro-adenomas. As I understand it, 3 cm is quite large and normally, would take several years to grow and would therefore, have shown up on a previous mammogram. The lump seems to move a bit and I have some discomfort especially when my son snuggles me or bumps into my breast. I have no discharge etc.
  The radiologist said it isn't round or black on the sonogram & mammogram which indicates it isn't a fibro-adenoma (sp?) or cyst. The lump shows up on the mammogram as sort of oblong and gray. He suggested I contact a surgeon and have an ultrasound biopsy.
  How is an ultrasound biopsy different from a surgical biopsy? Which is best?
  What questions should I ask? I realize you haven't seen the mammogram but I'd appreciate your opinion. How concerned should I be?
  Does your site have a list of questions I should bring to my doctor? I have an appointment 4/12 at 12:30. I would appreciate it it you could respond to my email asap. Thank you so much for your website.

[CCF-RN,MSN-rf]

Dear ellagurry:  An ultrasound biopsy uses the ultrasound to guide a needle to take a sample of the area in question, although, if the lump can be felt, there may be no need to use ultrasound.  Either way a needle takes a sample.  A surgical biopsy removes the lump.  Both procedures have pros and cons.  A needle biopsy takes a small sample and leaves no scar.  A surgical biopsy takes the whole area but it will likely leave a small scar and depending on the size of the remaining breast tissue, could leave a deformaty.  If there is concern that a needle biopsy cannot give an adequate sample, then a surgical biopsy might be better.  Once you meet with the surgeon, he/she may clarify better which one is recommended and why.

[surgeon]

when a lump is feelable, it's not necessary to do an ultrasound guided biopsy; that's what's done for something that shows on ultrasound but isn't feelable. Ultrasound biopsy typically involves using ultrasound to locate the area and to aim a biopsy needle at it. The same needle is used for other biopsies, when the lump is palpable; so really there's no difference. In some cases a surgical biopsy is chosen, which means, using either local anesthesia or going to sleep, making an incision and removing all or a portion of the lump. What you describe may or may not be significant: a large slightly tender lump which is moveable might well be what's called "mammary dysplasia," which is a common and harmless lump. However, any new lump needs some plan to achieve confidence in what it is. The choices are among careful followup, fine-needle aspiration biopsy (taking a sample with a small needle), core needle biopsy (taking a sample with a larger needle), or open surgical biopsy. Which makes most sense depends on many things, including the feel of the lump, the appearance on imaging studies, and the level of concern of you and your doctors.

[ellagurry]

Thank you for replying so quickly. I think the reason the doctor recommended an ultrasound biopsy is because it could be done quickly w/immediate results. Is an ultrasound biopsy thorough? What is the likelihood of an ultrasound biopsy not catching the presence of cancerous cells?  
   If it comes back as nonmalignant, are additional biopsies of the same or a different kind recommended? Or should I be satisfied w/good news if I get it? Similiarly, if it comes back as malignant is that the end of biopsies and would I then have to think about surgical options etc.?
  Finally, are there specific questions I should ask at my biopsy appointment tomorrow? Thanks again. I appreciate your getting back to me on a Sunday. It helps give me peace of mind.

[surgeon]

As I said above, the ultrasound biopsy uses a type of needle that is also used without ultrasound: if it's feelable, the needle can be used, as quickly, with the same result in the same time as if done with ultrasound. There's no difference other than whether it's necessary to aim the needle with ultrasound, or it can  be aimed directly at a feelable tumor. So speed is not the issue. It's whether to use a needle or to do an open biopsy; the former gets a sample, the latter gets either the whole lump or a larger portion of it. How reliable is a needle? It's a matter of context. It removes a core of tissue which is generally high representative. One can say it's most foolproof to remove the whole lump; but a core needle sample is very rarely wrong, as long as it's confident that the core was taken from the right place. That's the question to ask the surgeon: which biopsy does she/he think is best, and why. What is the chance that the biopsy result would be unreliable, and why?