Which type of biopsy if possible hemangioma

Two years ago I began having pain in the outer quadrant of my left breast. Could not palpate anything but I have dense breasts and dysplasia. Asked for a more involved mammogram at my annual then, and they did some extra films. Nothing was found. Went last week and requested a 3D imaging and voila, a 1.2 cm lesion in the area that has bothered me popped up. Was told because of my higher than average risks for BC that I should have US which was scheduled for a couple days later. I have asked several times now whether this was present last time, but received no answer, and based upon my conversations with the US tech, I think they probably missed it. The quality of imaging services in my area is pretty bad. I have been told things in the past like I was missing a lumbar section that in fact was there but collapsed to the point no disc space showed. A couple years ago I was sent for a CT scan of my ovaries and they did not even image them. They have misreported sizes of things and tried to convince me to have tests that it turned out I never needed...So with that kind of history, I wait until I can understand what is going on before I sign up for diagnostic studies.

The lesion sits deep and atop my chest wall. The image showed an oval black mass with some light area to one side that was supposedly the US beam or similar passing through. After showing me the image at some length and recording and discussing its qualities, the technician then called the radiologist in for final analysis. He jammed a probe painfully into the area in question and bore down for 5 minutes while he tried to figure out how to use the equipment! He kept making adjustments and asking her what to do to try to improve the image quality. Finally even the tech said, you are hurting her and he gave up. Said the finding was inconclusive and he wanted to do a core biopsy right then and there! Said he also "thought" it was vascular. I told them I needed time to absorb this information and to their very apparent chagrin, I left. The tech insisted I call in on Monday to schedule a core biopsy ASAP.

I plan to get copies of everything tomorrow and I am going to look for a breast surgeon to take over from here. But I am trying to figure out how to approach this because of some health complications. First of all, I have pericarditis and can't tolerate anything that can speed up heart rate, not even caffeine. I read that biopsies are usually accompanied by lidocaine with epinephrine in it, and the latter would be a no go for me given my current health status. I am also a bleeder. Surgeries and even simple dental procedures have gone awry in the past with me, so bleeding is a big issue and is exacerbated by medicines I currently take.

Secondly, I think the lesion could possibly be a hemangioma which are known to bleed profusely. I perused a lot of US images and selected ones that most resembled what I was shown at the appointment and this popped up as a possibility. I have them elsewhere in my body. So I am very nervous about having needles shoved into this area for a core biopsy.

So am wondering what options I might discuss with a surgeon going forward? I have a child in college and definitely am not going to take a complacent view of this. I hate to do the Dr. Google thing, but last year it saved my life when I was misdiagnosed with GERD vs a very bad case of pericarditis and went untreated for 6 weeks while my health deteriorated to a critical degree. But in this case I am not sure how to proceed. I need to know what this thing is, but I need to do something that is either minimally invasive, or, offers the kind of support you get in an operating theater versus an outpatient clinic. I know that these tests are safe as things go, but I am still fairly fragile in health. However, I want a definitive diagnosis. Is it possible to just skip the biopsy and take the darn thing out? It is super painful. Would an MRI or Pet scan give them data? Needless to say I am feeling confused. And to complicate things, my family is going abroad in a matter of days (am not accompanying them) so hoping to figure out something before they leave in case I need support.

There is actually a nation-wide shortage of SOME concentrations of lidocaine + epinephrine currently. (I work at a hospital pharmacy.) We don't have problems getting plain lidocaine injectable (so far.) Depending on your particular situation, there are some medications that some physicians use to lower their risk of bleeding, such as aminocaproic acid or tranexemic acid (both intravenous.) They sometimes use these, for example, when a woman is at high risk of hemorrhage after delivery. These may or may not be appropriate for you. However, they are normally given by IV, and I've never had an IV for any of the breast biopsies I've had.

I bleed a lot after my 2nd core biopsy; I had a big hematoma. They had to compress my breast for an hour or two, and said if I continue to bleed in the evening to come back to the ER. After a few days, my breast turned all sorts of beautiful autumnal shades (yellow, blue, purple, green), but eventually the blood hemoglobin resorbed, after months. Luckily, I am not employed as a stripper, and probably most women here aren't either. It only looked horrible, it didn't feel horrible.

Esperanza, given your prior history with less than stellar recommendations from the local imaging center, coupled with your other health conditions, I don't blame you being reluctant to have them investigate further. I think your idea of seeking a breast specialist's recommendation (I would absolutely send/bring all copies of images and written imaging reports for his/her review) is a good one. Worst case scenario, he/she recommends the same thing, best case, he/she orders additional imaging (at another locale) and decides it is in fact b9 and does not recommend biopsy. Either way, you'll have more confidence in that person's recommendations and you can give them your medical history to insure that all appropriate precautions are taken on your behalf. I would encourage you to "travel" a bit (the closest major center) to insure that the breast specialist sees a large enough number of women to focus on breasts exclusively. You may not be able to get in asap, but it would be worth the extra drive. Good luck for b9 results!