Breast Biopsy
Test Description
Several diagnostic tests, including mammography and sonography, are used in the
evaluation of breast masses. However, determination of whether a mass is malignant
can only be made by obtaining a biopsy of the tissue. The tissue sample may
be obtained via needle aspiration, by core biopsy, or by open incision. Breast biopsy
is also used when there has been an observable change in the breast, such as skin
ulceration or nipple drainage.
ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
THE EVIDENCE FOR PRACTICE
Large core imaging-guided breast biopsy is now the technique of choice in many institutions
in the United States for biopsy of nonpalpable breast masses and abnormal calcifications.
Either stereotactic or ultrasound-guided breast biopsy may be used for reliable diagnosis of
breast cancer.
Normal Values
No abnormal cells or tissue present
ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
Possible Meanings of Abnormal Values
Adenofibroma
Breast cancer
Fibrocystic disease
Inflammatory breast cancer
Intraductal papilloma
Mammary fat necrosis
Plasma cell mastitis
ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
Interventions/Implications
Pretest
• Explain to the patient the purpose of the test and the procedure to be done.
• The biopsy is usually obtained using a local anesthetic, although general anesthesia is an
option.
• No fasting is required prior to the test, unless general anesthesia is to be used.
• Obtain a signed informed consent.
Procedure
• The patient is assisted to a supine position.
• The skin is cleansed with an antiseptic and draped.
• A local anesthetic is typically administered.
• Gloves are worn throughout the procedure.
For a needle biopsy
• For a fine needle aspiration biopsy, a needle is inserted into the mass, and a sample of tissue
or fluid is aspirated into the syringe. A slide of the aspirate is made for cytology
review. A sterile dressing is applied.
• For a core needle biopsy, a very small incision is made and multiple samples are taken
of the lesion using a commercially available device. This device is spring-loaded and
allows the health-care provider to obtain samples which fill the needle core. The tissue
specimens are placed in a specimen container with normal saline solution or formaldehyde.
Steri-strips and a sterile pressure dressing are applied to the incision.
For an open biopsy
• An incision is made in the breast to expose the mass.
• The mass is then excised in entirety if it is smaller than 2 cm in size. If the mass is larger
or appears malignant, a portion of the mass is excised.
• The tissue specimen is placed in a specimen container with normal saline solution or
formaldehyde.
• If the mass appears malignant, the tissue sample is sent for frozen section and receptor
assays. Do not place tissue for receptor assay testing in formaldehyde.
• The wound is sutured, and a sterile dressing is applied.
Posttest
• For biopsy under local anesthesia, check vital signs after the procedure. If general anesthesia
was used, check vital signs every 15 minutes for the first hour, every 30 minutes
for the next hour after that, every hour for 4 additional hours, and then every 4 hours.
• Check the dressing for drainage.
• Teach the patient to monitor the site and to notify the health-care provider if signs or
symptoms of infection occur, such as drainage, redness, warmth, edema, pain at the site,
or fever.
• Administer analgesics as needed.
• Provide emotional support as the patient awaits test results.
• Report abnormal findings to the primary care provider.
Clinical Alerts
• The finding of an abnormality in the breast and then waiting for test results can
be quite anxiety-producing for the patient. If possible, schedule testing (mammography
and sonography) on the same day and at a time when a speciallytrained
radiologist would be available to perform a needle biopsy, if warranted.
• Potential complication of the procedure is infection.
CONTRAINDICATIONS!
• Patients unable to cooperate with the examination
Several diagnostic tests, including mammography and sonography, are used in the
evaluation of breast masses. However, determination of whether a mass is malignant
can only be made by obtaining a biopsy of the tissue. The tissue sample may
be obtained via needle aspiration, by core biopsy, or by open incision. Breast biopsy
is also used when there has been an observable change in the breast, such as skin
ulceration or nipple drainage.
ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
THE EVIDENCE FOR PRACTICE
Large core imaging-guided breast biopsy is now the technique of choice in many institutions
in the United States for biopsy of nonpalpable breast masses and abnormal calcifications.
Either stereotactic or ultrasound-guided breast biopsy may be used for reliable diagnosis of
breast cancer.
Normal Values
No abnormal cells or tissue present
ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
Possible Meanings of Abnormal Values
Adenofibroma
Breast cancer
Fibrocystic disease
Inflammatory breast cancer
Intraductal papilloma
Mammary fat necrosis
Plasma cell mastitis
ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
Interventions/Implications
Pretest
• Explain to the patient the purpose of the test and the procedure to be done.
• The biopsy is usually obtained using a local anesthetic, although general anesthesia is an
option.
• No fasting is required prior to the test, unless general anesthesia is to be used.
• Obtain a signed informed consent.
Procedure
• The patient is assisted to a supine position.
• The skin is cleansed with an antiseptic and draped.
• A local anesthetic is typically administered.
• Gloves are worn throughout the procedure.
For a needle biopsy
• For a fine needle aspiration biopsy, a needle is inserted into the mass, and a sample of tissue
or fluid is aspirated into the syringe. A slide of the aspirate is made for cytology
review. A sterile dressing is applied.
• For a core needle biopsy, a very small incision is made and multiple samples are taken
of the lesion using a commercially available device. This device is spring-loaded and
allows the health-care provider to obtain samples which fill the needle core. The tissue
specimens are placed in a specimen container with normal saline solution or formaldehyde.
Steri-strips and a sterile pressure dressing are applied to the incision.
For an open biopsy
• An incision is made in the breast to expose the mass.
• The mass is then excised in entirety if it is smaller than 2 cm in size. If the mass is larger
or appears malignant, a portion of the mass is excised.
• The tissue specimen is placed in a specimen container with normal saline solution or
formaldehyde.
• If the mass appears malignant, the tissue sample is sent for frozen section and receptor
assays. Do not place tissue for receptor assay testing in formaldehyde.
• The wound is sutured, and a sterile dressing is applied.
Posttest
• For biopsy under local anesthesia, check vital signs after the procedure. If general anesthesia
was used, check vital signs every 15 minutes for the first hour, every 30 minutes
for the next hour after that, every hour for 4 additional hours, and then every 4 hours.
• Check the dressing for drainage.
• Teach the patient to monitor the site and to notify the health-care provider if signs or
symptoms of infection occur, such as drainage, redness, warmth, edema, pain at the site,
or fever.
• Administer analgesics as needed.
• Provide emotional support as the patient awaits test results.
• Report abnormal findings to the primary care provider.
Clinical Alerts
• The finding of an abnormality in the breast and then waiting for test results can
be quite anxiety-producing for the patient. If possible, schedule testing (mammography
and sonography) on the same day and at a time when a speciallytrained
radiologist would be available to perform a needle biopsy, if warranted.
• Potential complication of the procedure is infection.
CONTRAINDICATIONS!
• Patients unable to cooperate with the examination
تعليقات
إرسال تعليق