My Breasts, My Cure - Chapter Three

Chapter Three

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Ultrasound and Biopsies

         I return to the Women Imaging Center. I watch Mrs. Davies, the technologist, as she studies the ultrasound monitor intently. It is as if she were wishing that the dense cells would disappear when she navigates the transducer along my slippery breast where gel has been applied. It is fascinating to watch the effects of high frequency sound waves sent off through the skin. The picture on the monitor looks like ocean waves that bounce when they encounter a boat (the tumor). I don't like seeing the boats. They look dark and ominous.

         "The waves bounce back because the cyst is solid," Mrs. Davies explains after asking her. I am quite inquisitive and want to know everything that is going on. She is very responsive to my questions, except when I delve into something sensitive, then she'd say: "I am not a doctor. Dr. Cole will explain that to you."

         "Why do we need both ultrasound and mammogram to check for anomalies?" I ask.

         "There are certain things that each one can pick up," she begins. "Younger breasts are less fatty, which makes the detection of abnormal tissues easier through mammograms."

         I guess that means that for older breasts like mine, though still firm, I need both technologies to find the nasty cells that have invaded my precious breasts.

         "Actually, mammography can pick up very small lesions and pre-cancer cells," she continues. "However, mammograms can only pick up part of the breast that sticks out and can be clamped by the plates. The periphery of the breast cannot be photographed at all. Also, if the breasts are dense, the lump may not be visible through the tissue. Large breasts are easier to mammogram than small breasts; therefore, in general, Asian women are more difficult to mammogram."

         This woman must have been a teacher at one point. She enjoys the lecture and she's good at it.

         "Now, you have good size breasts," she proceeds with a smile, "so you're easy to do."

         Without asking for any further explanation, she voluntarily continues to educate me. She must not get a lot of inquisitive patients to satisfy her mentoring mind. "Breast tissues show up white on the mammogram while fat shows up dark. As women age and reach menopausal, very little tissue is left unless the woman is on hormone therapy. A thinner woman is more likely to have tissue in her breast.

         Oh, great. Where are those mammograms for me to review? As I can remember without prejudice, I think I saw a lot of white in the films when Dr. Cole was reviewing them. In fact, I thought of the Milky Way when looking at those films. I've read somewhere that those are called micro-calcification, and that means no-good.

         I learn further from my friendly educator that in ultrasound, no radiation is used; therefore, it is more appealing to most people. However, it cannot pick up small details like in mammography even though it can show other characteristics in a lump. It helps us determine whether the cyst is fluid-filled or solid. If fluid-filled, the sound waves go through the cyst, whereas if solid, the sound waves bounce back.

         So, if a mammogram shows a dense tissue and the doctor feels a lump, the ultrasound may see if there's a lump within the dense tissue. In the ultrasound method, high frequency sound waves are sent off in little pulses, like radar, toward the breast. The downside of ultrasound is its dependence in the technologist's skills in manipulating the transducer and her ability to interpret the image. I have confidence in Mrs. Davies.

         An hour later, I lie down on the table with my right breast suspended through a hole on the table, clamped between two x-ray plates. Dr. Cole and Mrs. Davies keep apologizing for the pinching, pulling, squeezing and clamping of my breasts. I keep responding: "I'm fine, thank you."

         Dr. Cole makes a nick with a scalpel in my breast's skin for the biopsy needle, and then localizes the area with lidocaine. He inserts the biopsy needle through the nick and into the tumor to remove a core of tissue. I feel an uncomfortable pressure when the core is taken out but no pain. The same procedure is done on both breasts, one on the left, two on the right breast at 72mph when drilling for a core of tissue.

         I like this procedure much better than the surgical biopsy I had five years ago, before the needle biopsy was invented. I still have the small scar where the one-inch incision was made at the edge of the areola so it's not obvious. At that time, the doctor removed the entire cyst to biopsy. The procedure is still done today when the doctors feel it safer to remove the entire lump. The thing is, it could be benign, just like my cyst then, but now, you're left with a scar that would never go away.

         "You did very well," Dr. Cole says when it was over. "I hope we didn't hurt you too much."

         "No. You did well." I say. "And no, you didn't hurt me at all."

         "The results should be available in three days," Dr. Cole says. He shakes my hand again. "I will call you once I get the pathology report."

         It took four hours for the ultrasound and biopsies. I would have stayed the whole day willingly if necessary.

         I leave the imaging center satisfied that I received the most professional and efficient service I could have gotten.

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Next item: "My Breasts, My Cure-- Chapter Four"