Stereotactic Biopsy, Breast

Stereotactic Biopsy, Breast

Synonym/acronym: N/A.

Common use

To assess suspicious breast tissue for cancer.

Specimen

Breast tissue or cells.

Normal findings

(Method: Macroscopic and microscopic examination of tissue) No abnormal cells or tissue.

Description

A stereotactic breast biopsy is helpful when a mammogram or ultrasound examination shows a mass, a cluster of microcalcifications (tiny calcium deposits that are closely grouped together), or an area of abnormal tissue change, usually with no lump being felt on a careful breast examination. A number of biopsy instruments and methods are utilized with x-ray guidance. They include large-core needle biopsy (LCNB) that is used to remove a generous portion of breast tissue for examination, fine-needle aspiration biopsy (FNAB), or a vacuum-assisted needle biopsy device. An initial x-ray locates the abnormality, and two stereo views are obtained, each angled 15° to either side of the initial image. The computer calculates how much the area of interest has changed with each image and determines the exact site in three-dimensional space. The sample of breast tissue is obtained and can indicate whether the breast mass is cancerous. A pathologist examines the tissue that was removed and makes a final diagnosis to allow for effective treatment.

This procedure is contraindicated for

  • high alertPatients undergoing biopsy who have bleeding disorders because the site may not stop bleeding.

Indications

  • A mammogram showing a suspicious cluster of small calcium deposits
  • A mammogram showing a suspicious solid mass that cannot be felt on breast examination
  • Evidence of breast lesion by palpation, mammography, or ultrasound
  • New mass or area of calcium deposits present at a previous surgery site
  • Observable breast changes such as “peau d’orange” skin, scaly skin of the areola, drainage from the nipple, or ulceration of the skin
  • Patient preference for a nonsurgical method of lesion assessment
  • Structure of the breast tissue is distorted

Potential diagnosis

Positive findings in carcinoma of the breast

Critical findings

    N/A

Interfering factors

  • Factors that may impair clear imaging

    • Metallic objects (e.g., jewelry, body rings, dental amalgams) within the examination field, which may inhibit organ visualization and cause unclear images.
    • Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or mental status.

  • Other considerations

    • Failure to follow dietary restrictions before the procedure may cause the procedure to be canceled or repeated.
    • Consultation with a health-care practitioner (HCP) should occur before the procedure for radiation safety concerns regarding younger patients or patients who are lactating. Pediatric & Geriatric Imaging Children and geriatric patients are at risk for receiving a higher radiation dose than necessary if settings are not adjusted for their small size. Pediatric Imaging Information on the Image Gently Campaign can be found at the Alliance for Radiation Safety in Pediatric Imaging (www.pedrad.org/associations/5364/ig/).
    • Risks associated with radiation overexposure can result from frequent x-ray procedures. Personnel in the room with the patient should wear a protective lead apron, stand behind a shield, or leave the area while the examination is being done. Personnel working in the examination area should wear badges to record their level of radiation exposure.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this procedure can assist in assessing breast health.
  • Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex or anesthetics, or sedatives.
  • Obtain a history of the patient’s reproductive system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Note any recent procedures that can interfere with test results.
  • Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women.
  • Obtain a list of the patient’s current medications, including anticoagulant therapy, aspirin and other salicylates, herbs, nutritional supplements, and nutraceuticals, especially those known to affect coagulation (see Effects of Natural Products on Laboratory Values online at DavisPlus). It is recommended that use be discontinued 14 days before surgical procedures. The requesting HCP and laboratory should be advised if the patient regularly uses these products so that their effects can be taken into consideration when reviewing results.
  • Review the procedure with the patient. Address concerns about pain related to the procedure and explain that some pain will be experienced during the test, or there may be moments of discomfort. Inform the patient that the procedure is performed in a special room, usually a mammography suite, by an HCP specializing in this procedure, with support staff, and takes approximately 30 to 60 min.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Explain that an IV line may be inserted to allow infusion of IV fluids such as normal saline, anesthetics, sedatives, or emergency medications.
  • Instruct the patient to remove jewelry and other metallic objects from the area of the procedure.
  • Instruct the patient to avoid taking anticoagulant medication or to reduce dosage as ordered prior to the procedure. Number of days to withhold medication is dependent on the type of anticoagulant.
  • Instruct the patient that, to reduce the risk of nausea and vomiting, solid food and milk or milk products have been restricted for at least 8 hr, and clear liquids have been restricted for at least 2 hr prior to general anesthesia, regional anesthesia, or sedation/analgesia (monitored anesthesia). The American Society of Anesthesiologists has fasting guidelines for risk levels according to patient status. More information can be located at www.asahq.org. Patients on beta blockers before the surgical procedure should be instructed to take their medication as ordered during the perioperative period. Protocols may vary among facilities.
  • Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.
  • The procedure may be terminated if chest pain or severe cardiac arrhythmias occur.

Intratest

  • Potential complications:

  • Complications include cardiac arrhythmias; bleeding related to a bleeding disorder, or the effects of natural products and medications known to act as blood thinners; infection that might occur if bacteria from the skin surface is introduced at the IV needle insertion site; or seeding of the biopsy tract.

  • Ensure that the patient has complied with dietary and medication restrictions.
  • Ensure that anticoagulant therapy has been withheld for the appropriate number of days prior to the procedure. Number of days to withhold medication is dependent on the type of anticoagulant. Notify the HCP if patient anticoagulant therapy has not been withheld.
  • Ensure the patient has removed all external metallic objects from the area to be examined prior to the procedure.
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Have emergency equipment readily available.
  • Administer ordered prophylactic steroids or antihistamines before the procedure if the patient has a history of severe allergic reactions to any substance or drug.
  • Instruct the patient to void and change into the gown, robe, and foot coverings provided.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen containers with the corresponding patient demographics, date and time of collection, and site location (left or right breast).
  • Instruct the patient to cooperate fully and to follow directions. Instruct the patient to remain still throughout the procedure because movement produces unreliable results.
  • Record baseline vital signs and assess neurological status. Protocols may vary among facilities.
  • Establish an IV fluid line for the injection of saline, sedatives, or emergency medications.
  • Place the patient in the prone or sitting position on an examination table. Cleanse the selected area, and cover with a sterile drape.
  • A local anesthetic is injected at the site, and a small incision is made or a needle inserted.
  • Instruct the patient to inhale deeply and hold his or her breath while the images are taken, and then to exhale after the images are taken.
  • Instruct the patient to take slow, deep breaths if nausea occurs during the procedure. Monitor and administer an antiemetic agent if ordered. Ready an emesis basin for use.
  • Monitor the patient for complications related to the procedure (e.g., allergic reaction, anaphylaxis, bronchospasm).
  • Remove the needle or catheter and apply a pressure dressing over the puncture site.
  • Observe/assess the needle/catheter insertion site for bleeding, inflammation, or hematoma formation.
  • Place tissue samples in properly labeled specimen containers, and promptly transport the specimens to the laboratory for processing and analysis.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Instruct the patient to resume usual diet and medications, as directed by the HCP.
  • Monitor vital signs and neurological status every 15 min for 1 hr, then every 2 hr for 4 hr, and then as ordered by the HCP. Take temperature every 4 hr for 24 hr. Monitor intake and output at least every 8 hr. Compare with baseline values. Notify the HCP if temperature is elevated. Protocols may vary among facilities.
  • Observe for delayed allergic reactions, such as rash, urticaria, tachycardia, hyperpnea, hypertension, palpitations, nausea, or vomiting.
  • Instruct the patient to immediately report symptoms such as fast heart rate, difficulty breathing, skin rash, itching, chest pain, persistent right shoulder pain, or abdominal pain. Immediately report symptoms to the appropriate HCP.
  • Observe/assess the biopsy site for bleeding, inflammation, or hematoma formation.
  • Instruct the patient in the care and assessment of the site.
  • Recognize anxiety related to test results, and be supportive of the potential perceived loss of body image. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Decisions regarding the need for and frequency of breast self-examination, mammography, magnetic resonance imaging (MRI) of the breast, or other cancer screening procedures should be made after consultation between the patient and HCP. The American Cancer Society (ACS) recommends breast examinations be performed every 3 yr for women between the ages of 20 and 39 yr and annually for women over 40 yr of age; annual mammograms should be performed on women 40 yr and older as long as they are in good health. The ACS also recommends annual MRI testing for women at high risk of developing breast cancer. Genetic testing for inherited mutations (BRCA1 and BRCA2) associated with increased risk of developing breast cancer may be ordered for women at risk. The test is performed on a blood specimen. The most current guidelines for breast cancer screening of the general population as well as of individuals with increased risk are available from the ACS (www.cancer.org), the American College of Obstetricians and Gynecologists (ACOG) (www.acog.org), and the American College of Radiology (www.acr.org). Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include biopsy breast, cancer antigens, ductography, mammography, MRI breast, and US breast.
  • Refer to the Reproductive System table at the end of the book for related tests by body system.