There are seven key factors that influence the amount of pain during a core needle biopsy when breast cancer is suspected.
The key variables influencing pain:
• Duration of the core needle biopsy
• Type of breast tissue to be biopsied
• Number of passes
• Biopsy depth
• Underlying pathology
• Human factors of the operator
• Patient’s mindset
In a study, 150 women underwent a core needle biopsy consisting of three to nine 14-gauge breast passes taken while the women lied face down on a specialized table.
None of the women had palpable lumps; rather, suspicious lesions had been detected on mammograms.
After the procedure the women filled out a questionnaire.
Factors NOT Cauasing Pain
During Core Needle Biopsy
• The lying position on the table
• Underlying pathology (e.g., whether benign or malignant)
• Operator features (performance, gender)
Factors that DO Cause Pain
During Core Needle Biopsy
The Hemmer et al study found that type of breast tissue is a factor. Women with dense breasts reported more pain.
Next, depth of the biopsy correlated to pain. Not surprisingly, deep insertions hurt more than more shallow ones.
Also not surprisingly, number of passes was a factor—to pain felt in the neck and shoulder.
Finally, duration of lying on the table (though the actual position itself wasn’t uncomfortable—be sure you understand that distinction) correlated to neck pain.
All of the patients in this study stated that they’d undergo a core needle biopsy again if recommended. Sixty percent said it was not painful.
If these pain correlations have you feeling uneasy, then realize that core needle biopsies (which use ultrasound technology) have advantages over fine needle biopsies.
• More likely to collect an adequate tissue sample
• Less invasive
• More likely to provide a definitive diagnosis
What can be done to keep pain minimized
during a core needle biopsy?
• Adequate local anesthesia is very important, stress the study’s authors.
• Next, make sure that you are set up as comfortably as possible on the table. But remember, the longer the procedure, the more likely you’ll experience a neck ache.
• If the patient likes their operator’s “bedside manner,” this will have a psychological effect on minimizing pain. See if you can chat with your operator before the procedure is scheduled.
• Communication during the procedure helps reduce discomfort. If you think you’ll be wanting to ask questions during the procedure, or will want to hear a narrative of what’s going on during the procedure at each step, make sure that your operator is amenable to this.
• The more experienced the biopsy team is, the shorter the procedure will be – which means a higher likelihood of less pain. You’ll want a radiographer with a lot of experience.
As you can see, there are factors (such as breast density and depth of needle) that a patient cannot control, that correlate to pain during a core needle biopsy.
However, when all factors are considered, there’s much that she CAN control – including mindset once she learns as much a possible about this safe and reliable procedure ahead of time. The full report appears in European Radiology.