Riedel Fabian, Hahn Markus, Bader Werner, Schäfgen Benedikt, Fastner Sarah, Hennigs André, Gomez Christina, Stieber Anne, Fastner Christian, Wallwiener Markus, Golatta Michael, Heil Jörg, Fallenberg Eva Maria
Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany.
Department for Women's Health, Tübingen University Hospital, Tübingen, Germany.
Breast Care (Basel). 2024 Apr;19(2):87-94. doi: 10.1159/000536079. Epub 2024 Jan 10.
Pre-therapeutic histologic diagnosis through image-guided core needle biopsy (CNB) or vacuum-assisted biopsy (VAB) for suspicious breast findings is a standard procedure. Despite the moderate risk of bleeding, a significant proportion of patients are on temporary or permanent anti-coagulation therapy (ACT) or anti-platelet therapy (APT). Currently, there are no established guidelines for managing biopsies in such patients, leading to varying approaches in clinical practice.
An online survey was conducted among all members of the breast ultrasound working group at the German Society for Ultrasound in Medicine (DEGUM) and the working group for breast diagnostics at the German Radiology Society (DRG). It included = 51 questions about individual risk perception of biopsy-related bleeding complications and the specific management of biopsies on ACT/APT.
A total of 332 experts participated, with 51.8% reporting the absence of a standardized management plan for breast biopsies on ACT/APT. Concerning specific ACT/APT medications, the survey revealed discrepancies in risk perception and management: The majority preferred discontinuing medication with directly acting oral anti-coagulants (DOACs; CNB: 66.9%; VAB: 91.1%), phenprocoumon (CNB: 74.9%; VAB: 96.7%), or therapeutic heparin (CNB: 46.1%; VAB: 72.7%). However, there was a lower inclination to discontinue acetylsalicylic acid (ASA; CNB: 15.2%; VAB: 50.3%) or prophylactic heparin (CNB: 11.9%, VAB: 36.3%).
Breast biopsies for patients on ASA or prophylactic heparin are deemed safe and part of standard clinical practice. However, despite available feasibility studies, conducting breast biopsies on ACT medications such as DOACs or phenprocoumon appears feasible only for a minority of experts.
通过影像引导下的粗针穿刺活检（CNB）或真空辅助活检（VAB）对可疑乳腺病变进行治疗前组织学诊断是一种标准程序。尽管出血风险中等，但相当一部分患者正在接受临时或永久性抗凝治疗（ACT）或抗血小板治疗（APT）。目前，对于此类患者的活检管理尚无既定指南，导致临床实践中的处理方法各不相同。
对德国医学超声学会（DEGUM）乳腺超声工作组和德国放射学会（DRG）乳腺诊断工作组的所有成员进行了一项在线调查。调查包括51个关于活检相关出血并发症的个体风险认知以及ACT/APT患者活检的具体管理问题。
共有332名专家参与，51.8%的专家报告称对于接受ACT/APT治疗的患者，乳腺活检缺乏标准化管理方案。关于具体的ACT/APT药物，调查显示在风险认知和管理方面存在差异：大多数人倾向于停用直接作用口服抗凝剂（DOACs；CNB：66.9%；VAB：91.1%）、苯丙香豆素（CNB：74.9%；VAB：96.7%）或治疗性肝素（CNB：46.1%；VAB：72.7%）。然而，停用阿司匹林（ASA；CNB：15.2%；VAB：50.3%）或预防性肝素（CNB：11.9%，VAB：36.3%）的倾向较低。
对于服用ASA或预防性肝素的患者，乳腺活检被认为是安全的，并且是标准临床实践的一部分。然而，尽管有可行性研究，但对于少数专家来说，对服用DOACs或苯丙香豆素等ACT药物的患者进行乳腺活检似乎才可行。
