Department of Surgery, University of Cincinnati Medical Center, 3188 Bellevue Avenue, Cincinnati, OH 45219, United States of America.
University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States of America.
Clin Imaging. 2023 Dec;104:110017. doi: 10.1016/j.clinimag.2023.110017. Epub 2023 Nov 10.
Bleeding is a well-known risk of percutaneous breast biopsy, frequently controlled with manual pressure. However, significant bleeding complications may require further evaluation or intervention. Our objectives were to assess the rate, type, and periprocedural management of significant bleeding following percutaneous breast biopsy and to evaluate the success of any interventions.
We retrospectively reviewed percutaneous breast biopsies at our institution over a 10-year period with documented post-biopsy bleeding complications in radiology reports. Patients were included if bleeding required intervention (interventional radiology [IR], surgery, or other), imaging follow-up, or clinical evaluation for symptoms. Additional data included patient demographics, anticoagulation, history of bleeding diathesis, biopsy details, bleeding symptoms, histopathology, and intervention details, if applicable.
Of 5820 unique patients who underwent percutaneous biopsy, 66 patients (66/5820; 1.1%) comprising 71 biopsy cases met inclusion for clinically significant bleeding with 5/71(7.0%) requiring surgery, 9/71(12.7%) requiring IR intervention, and 57/71(80.3%) requiring lower-acuity intervention including prolonged observation (5/57;7.0%), overnight admission (4/57;5.6%), aspiration (4/57;5.6%), lidocaine and suture (2/57;2.8%), primary care visit (7/57;10.0%), blood transfusion (1/57;1.4%), emergency room visit (6/57;8.5%), surgery consult (8/57;11.3%), IR consult (2/57;2.8%), and follow-up imaging (22/57;31.0%). Most patients requiring intervention by surgery or IR had acute signs of bleeding immediately after biopsy while most patients with delayed signs of bleeding required lower-acuity interventions.
Clinically significant bleeding is extremely rare after percutaneous breast biopsy and is most often managed non-surgically. Developing an institutional algorithm for management of bleeding complications that consults IR before surgery may help decrease the number of patients managed surgically.
出血是经皮乳腺活检的已知风险，通常通过手动按压进行控制。然而，严重的出血并发症可能需要进一步评估或干预。我们的目的是评估经皮乳腺活检后严重出血的发生率、类型和围手术期管理，并评估任何干预措施的效果。
我们回顾性分析了本机构 10 年来的经皮乳腺活检，影像学报告中记录了活检后的出血并发症。如果出血需要干预（介入放射学 [IR]、手术或其他）、影像学随访或临床症状评估，则纳入患者。其他数据包括患者的人口统计学特征、抗凝治疗、出血倾向史、活检细节、出血症状、组织病理学和干预细节（如适用）。
在 5820 例接受经皮活检的患者中，有 66 例（66/5820；1.1%）71 例活检病例符合严重出血的纳入标准，其中 5/71（7.0%）需要手术，9/71（12.7%）需要 IR 干预，57/71（80.3%）需要低危干预，包括延长观察（5/57；7.0%）、过夜留观（4/57；5.6%）、抽吸（4/57；5.6%）、利多卡因和缝合（2/57；2.8%）、普通门诊就诊（7/57；10.0%）、输血（1/57；1.4%）、急诊就诊（6/57；8.5%）、手术咨询（8/57；11.3%）、IR 咨询（2/57；2.8%）和随访影像学（22/57；31.0%）。大多数需要手术或 IR 干预的患者在活检后立即出现急性出血迹象，而大多数出现延迟出血迹象的患者需要进行低危干预。
经皮乳腺活检后发生严重出血的情况极为罕见，且大多数可通过非手术方式治疗。制定一种在手术前咨询 IR 的机构出血并发症管理算法，可能有助于减少手术治疗的患者数量。
