MRI-guided biopsies are not all that common. In my cancer centre they do less than 10 a year. It’s a complex, highly specialized procedure that takes about 90 min. I didn’t know this at the time. I just knew I had a week to get one and get the results so I could keep my surgery date. Add to that the stress of the possibility that now there might be something in my right breast. At least I’d be balanced, I told my friends – if they’re taking something out of the left I guess they might as well take a bit from the right to keep the girls equal. Sigh. And, up front I will say that I was so glad I’d arranged to have a friend pick me up and take me home after this biopsy – smartest thing I’d done recently.
The radiologist described an MR biopsy like a game of Battleship in reverse. They know the general area of the blob they need to biopsy, and now they will use a grid on a mammogram-like paddle to line up the blob in a smaller and smaller grid to guide the needle.
Let’s talk about the needle. Remember my fear about metal from my last MRI (just a week before)? Well, now we’re talking about a piece of metal that is going to be stuck in your boob and then stay in you while you’re shoved back inside the giant magnet donut. Unlike my hip, that piece of metal can surely fly out, right? Wrong – it’s titanium, a non-ferrous metal (as is my hip). Plus, that needle is specially designed for this purpose.
They move you in and out and in and out of the donut as they inch the grid pattern closer and closer to target the suspicious blob. This blob can only be seen on the MRI – it’s too small for the ultrasound – and MRI is not realtime, so it’s a guessing game of millimetres each time the grid is positioned. And, you’re lying face down, with your boobs through a hole hanging down. The right boob was squeezed between the paddles – more like a mammogram – so they can be as accurate as possible.
And, they remind you constantly – don’t move. Hmmmm, I’m face down, with ear plugs and headphones on to blunt the noise the MRI magnet makes, and my right boob is squeezed tightly between two plastic paddles. Plus I have an IV line in my right arm feeding dye into me. I’m not going anywhere in a hurry.
Again – if it wasn’t happening specifically to me, it would be a very cool procedure. Truly fascinating. The fact that it was my boob in there and they were hunting for signs of more cancer diminished the cool factor, I have to say.
Once the grid is aligned with the blob inside your boob, they freeze your breast. Yes – you’ve been lying face down with your breast squeezed for about 30 min now and you can feel every tiny thing. I am not a huge fan of needles, but I can tell you that when it came time to get the freezing, that was a good thing. Freeze it good, I said – put in what you think is a lot, and then put more. A needle was about to be shoved through my breast from one side to the other – I did not want to take any chances. Again, I’m sure they are laughing at me during Rounds to this day … and I’m fine with that.
Needle inserted, wheeled back in to the magnet, placement verified, wheeled back out and the little suction machine is turned on. Whirrrr, click; whirrrr, click; whirrrr, click – twelve times. Twelve samples taken. Thank god that’s over.
Then a tiny little titanium marker is put in to mark the spot where the suspicious blob was. It couldn’t be seen on the ultrasound or mammogram, so they put in a marker to keep track on future mammos and ultrasounds.
Two days later the results are in – benign. Just a fibroid. I’ve never been so happy to say “all that for nothing!” Whew.
If the original ultrasound biopsy left my left boob looking like a truck ran over it with all the bruising, this MRI-guided biopsy left my right breast looking like a house fell on it. After a few days it was so black and blue and purple it looked more like a rock than a breast. I took pictures – funny how few friends wanted to see the documented evidence of healing as it turned from black to blue to pea green and piss yellow.
The surgery countdown was still on. Until I got the next phone call on a Friday afternoon at 4 pm. What is it with the end of the week and bad news?