One visit

Biopsy, read and consult

Results in 24 hours

Preliminary, not two weeks

No stitches

Local anesthesia only

Ultrasound guided

Straight to the lump

First question

Most breast lumps are not cancer

Most lumps women find turn out to be benign, and the most common causes are hormonal rather than malignant. Breast tissue also changes through the month, so a lump that comes and goes with your cycle behaves very differently from one that does not. Here is how a lump worth watching differs from one worth sampling.

Common, benign findings

  • Fibrocystic changes. Lumpy, tender tissue that shifts with your cycle. Very common, and a normal variation rather than a disease.
  • Cyst. A fluid filled sac, often tender and often appearing suddenly. Draining it during the aspiration usually resolves it on the spot.
  • Fibroadenoma. A smooth, firm, mobile lump. It is the most common solid benign tumor, most often in women under forty.
  • Fat necrosis. A firm area left behind by an injury, surgery or radiation. It can look worrying on imaging and is entirely benign.

Worth sampling

  • It is hard, fixed, or irregular. A painless, hard lump with irregular edges is the classic description, although breast cancers can also feel soft and rounded.
  • It has not changed with your cycle. A lump that stays the same through a full month, or that keeps growing, deserves cells.
  • The skin or nipple has changed. Dimpling, skin that looks like orange peel, redness, scaling, retraction, or discharge that is bloody or comes from one duct.
  • Imaging flagged it. A mammogram or ultrasound reported a suspicious finding, or there is an enlarged lymph node under the arm.

None of these signs means cancer. They mean the lump is worth sampling rather than watching. A fine needle aspiration answers the question in one appointment, which is a very different experience from waiting and wondering.

The reason to biopsy

What the cells can tell us

The reason to biopsy a breast lump is to rule out the worse possibility, and to do it before imaging alone leaves you waiting. Under the microscope the lump falls into one of three broad answers.

Not cancer

Benign

Fibrocystic tissue, a cyst, or a fibroadenoma, with cells in the proportions you would expect. This is the most common finding by a wide margin, and it is the answer most people come here hoping to hear. If it was a cyst, draining it during the visit often takes the lump with it.

Needs more information

Atypical

The cells are abnormal but not clearly malignant. Atypia is not a cancer diagnosis and it is not an answer on its own. It means the question needs a core biopsy or a surgical opinion to settle, and Dr. Nadelman tells you that on the day, explains which route fits, and helps arrange it rather than sending you back to the start.

Cancer of the breast

Carcinoma

Malignant cells, most often ductal or lobular carcinoma. Breast cancer found early is highly treatable, and carcinoma in situ is the earliest stage there is. Getting that answer from a needle sample in a single visit is what makes early treatment possible.

Two routes, same question

The difference is who reads your slides

In most of Los Angeles a breast lump biopsy is a referral to a hospital radiology department. A radiologist takes the sample, and a pathologist you never meet reads it days later.

Standard referral

Two visits, two specialists

  • Day 0. Referral and imaging
  • Day 3. A radiologist takes the sample
  • Day 12 to 14. Pathology report reaches your doctor
  • If the sample is short. You find out two weeks later and start over

About two weeks of waiting

With Dr. Nadelman

One appointment

One visit, one specialist

  • Day 0. Ultrasound, biopsy, slides read on site, consultation
  • Same day. If the sample is short she knows immediately and takes another
  • Within 24 hours. Preliminary results to you and your doctor
  • No second trip. You talk to the person who made the diagnosis

An answer inside of two days

Your appointment

What actually happens

A fine needle aspiration uses a needle thinner than the one used to draw blood. There is no incision and there are no stitches. Plan on about an hour.

01

Consultation and ultrasound

Dr. Nadelman examines the lump and looks at it on ultrasound first, so she knows exactly what she is sampling.

02

The aspiration

Local anesthesia, then a few passes with a fine needle. Most people find it easier than a blood draw.

03

Read on site

The slides are stained and examined in the office lab while you wait. This is the step that does not exist anywhere else.

04

You get answers

Preliminary findings usually within 24 hours, sent to whichever physician you name.

Celina-M-Nadelman-MD
Who reads your slides

Celina M. Nadelman, M.D.

One of very few physicians in the United States who is board certified in cytopathology and practices as a fine needle aspiration specialist. She performs the biopsy and she interprets it. There is no handoff.

  • Head of the FNA Clinic for Los Angeles County at the Martin Luther King, Jr. Outpatient Center
  • Clinical instructor, UCLA David Geffen School of Medicine
  • Co-Director of Pathology, Charles R. Drew University
  • Residency and fellowship at UCLA. M.D., Keck School of Medicine of USC

Waiting is the worst part. It does not have to take two weeks.

Next-day appointments are usually available, and house calls are available anywhere in California.

310.702.6701

1125 S. Beverly Drive, Suite 602
Los Angeles, CA 90035
Monday to Friday, 10 to 6

Before you call

Questions patients ask

Does a breast biopsy hurt?

Less than most people expect. The needle is thinner than the one used for a blood draw, the area is numbed first, and there is no incision, so there is nothing to stitch and nothing to heal. Most patients drive themselves home and go back to work the same day.

No. You can schedule directly with the office. If you do have a referring gynecologist or primary care physician, Dr. Nadelman sends them the report and is glad to talk through the findings with them. Because she reads the slides herself, that conversation happens with the person who made the diagnosis.

Yes, and it often treats a cyst in the same visit. Dr. Nadelman looks at the lump on ultrasound first. If it is a cyst, draining it with the same needle usually makes it disappear while you are there. If it is solid, she takes cells and reads them on site.

Preliminary findings are usually available within 24 hours, because the slides are stained and read in the office rather than shipped to an outside lab. If the sample is inadequate she knows during your visit and takes another one, so you are not called back two weeks later to start over.