Biopsy without at least US?

Well, it depends on whether you are talking about a true biopsy or a fine needle aspiration for a cyst. If the doctor strongly believes that the lump is a cyst, a FNA is a quick and easy procedure that can extract the fluid and deflate the cyst. I've had lots of cysts over the years and at times my doctor would do a FNA on the spot before sending me for imaging, because if the lump was a cyst, then no further action would be required. This would only happen when I had a large, palpable lump - easy for the doctor to find to insert the needle.

But the description of your mother's situation sounds a lot more complex than a normal cyst. In that case, normally mammogram and ultrasound screening would be done. Did the surgeon say anything about the appearance of your mother's breast? The scar and the thickened red skin warrants more investigation.

Do you know what type of biopsy has been ordered? A FNA is what's done for a cyst, but when we talk about breast biopsies, usually we are referring to stereotactic / core needle biopsies, which are either mammogram-guided (stereotactic) or ultrasound-guided. So if one of these types of biopsies has been ordered, then they come with the diagnostic mammogram and/or ultrasound screening. So it could be that the doctor is concerned enough that he has ordered the biopsy right away, along with the imaging, rather than scheduling the imaging first and then deciding on whether a biopsy is necessary. Another type of breast biopsy is a punch biopsy of the skin, which might also be appropriate in your mother's situation given the appearance of her skin, and this wouldn't require any imaging in advance.

So, definitely need more information about what's been ordered before saying whether there is any concern or anything missing in the process.

The plan for the biopsy may include ultrasound or mammographic guidance

Welcome icic! I'm with others hoping some sort of imaging will happen as a part of biopsy... Otherwise you may want to talk with your mother about asking for imaging... Obviously if the biopsy comes back positive there will be referrals and hopefully standard protocol for her situation. I guess I kind of wonder about that too since you said there is not even an oncologist in your parents' area... I hope your mom has access to good care if she needs additional follow-up even if that means a reasonable drive?

icic14, is your Mom in the US? If so, there is no way any medical facility would refuse to give prior confirmation as to what procedures (or possible procedures) they intend to do at an appointment. The question is who they can communicate this to. Now this may be a HIPAA issue where they cannot communicate other than with your Mom without her permission to speak to your Dad or you, but this isn’t just a “blank” anything-goes time slot. I do not doubt that a doctor could clearly recognize by appearance and/or clinical exam that she requires a referral for biopsy, even without having current imaging. The question is, where has she been referred to and exactly what procedures will be performed at that appointment? This sounds like a communication issue to me. Someone knows and can confirm what happens next so that determination can be made as to whether that plan is appropriate. What is appropriate is a mammogram, probably followed by an ultrasound and then an ultrasound or mammogram guided (stereotactic) core biopsy, subject to any limitations your mom’s current state of health

Just for the record, FNA biopsies are not optimal for most things because frequently they collect insufficient cellular material to make any definitive diagnosis. but at this tome you just think (and don’t know for sure) that this may or may not have been ordered.

Of course, your Mom’s health status and schizophrenia likely complicate all of this.

1) radiologists do get pretty good at assessing masses but sometimes they are wrong. That's why a biopsy is needed. Is there something which says BIRADS and then a number behind it?

2).those are just anatomical locations. Like saying north or south except in medicine. They sound a bit garbled - perhaps voice transcription software was used

3) depends on what is in the lymph nodes . She needs a biopsy.