SURGICAL BIOPSY OF BREAST LESION:
Surgical Biopsy: Surgical biopsy is the most common outpatient surgical procedure. Eight of 10 lesions are benign on biopsy. The procedure is usually done using local anesthesia, moderate sedation, or both. The biopsy involves excising the lesion and sending it to the laboratory for pathologic examination.
Extensional biopsy is the usual procedure for any palpable breast mass. The entire lesion, plus a margin of surrounding tissue, is removed. This type of biopsy may also be referred to as a lumpectomy. Depending on the clinical situation, a frozen section may be done at the time of the biopsy (a small piece of the mass or lesion is given a provisional diagnosis by the pathologist), so that the surgeon can provide the patient with a diagnosis in the recovery room.
Incisional biopsy is performed when tissue sampling alone is required; this is done both to confirm a diagnosis and to determine the hormonal receptor status. Complete excision of the area may not be possible or immediately beneficial to the patient, depending on the clinical situation. This procedure is often performed in women with locally advanced breast cancer or in cancer patients with a suspicion of recurrent disease, whose treatment may depend on the tumor’s estrogen and progesterone receptor status. These receptors are identified during pathologic examination of the tissue.
TRU-CUT CORE BIOPSY
In a Tru-Cut core biopsy, the surgeon uses a special large-lumen needle to remove a core of tissue. This procedure is used when a tumor is relatively large and close to the skin surface and the surgeon strongly suspects that the lesion is a carcinoma. If cancer is diagnosed, the tissue is also tested for hormone receptor status.
WIRE NEEDLE LOCALIZATION
Wire needle localization is a technique used when mammography detects minute, pinpoint calcifications (indicating a potential malignancy) or non palpable lesions and a biopsy is necessary. A long, thin wire is inserted, usually painlessly, through a needle before the excisional biopsy under mammographic guidance to ensure that the wire tip designates the area to undergo biopsy. The wire remains in place after the needle is withdrawn to ensure a precise biopsy. The patient is then taken to the operating room, where the surgeon follows the wire down and excises the area around the wire tip. The tissue removed is x-rayed at the time of the procedure; these specimen x-rays, along with follow-up mammograms taken several weeks later (after the site has healed), verify that the area of concern was located and removed.
Nursing Care of the Patient Undergoing a Breast Biopsy:
Breast biopsies are one of the most common ambulatory surgical procedures performed, with 80% of the results negative for malignancy (Norris, 2001). Prior to the procedure, the nurse’s role is to provide instruction; however, it is important for the nurse to first assess how the woman is coping with her need for the procedure and her ability to process information about the procedure and the possible implications of the biopsy results.
Anxiety and fear are normal responses to the need for a breast biopsy, but these responses may interfere with the woman’s ability to recall and understand the information that is provided prior to the procedure. Therefore, written information and booklets are used to reinforce teaching. The nurse also must give the patient an opportunity to address issues and concerns related to the biopsy. The nurse instructs the patient to avoid use of agents that can interfere with blood clotting and increase the risk for bleeding. Among these agents are non steroidal anti-inflammatory drugs, vitamin E supplements, herbal substances (such as gingko biloba and garlic supplements), warfarin, and products containing aspirin. The patient may be instructed not to eat or drink after midnight, depending on the type of biopsy planned.
Most breast biopsy procedures today are performed with the use of moderate sedation and local anesthesia; thus, the recovery period is relatively brief.
Postoperative assessment includes monitoring the effects of the anesthesia and inspection of the dressing covering the incision. Prior to discharge from the ambulatory surgery center or office, the patient must be able to tolerate fluids or food, ambulate, and void. The patient should be accompanied home by a family member or friend. At discharge, the nurse reviews with the patient the care of the biopsy site, pain management, and activity restrictions.
The dressing covering the incision is usually removed on the second day, but use of a supportive bra is encouraged immediately after the procedure for 3 to 7 days to limit movement of the breast and reduce discomfort. Steri-strips applied over the incision are left in place until they start to come off, usually a couple of weeks after the procedure. A follow-up telephone call to the patient by the nurse 24 to 48 hours after the procedure is standard care and provides an opportunity for the nurse to answer any questions the patient might have.
Most women return to their usual activities the day after the procedure but are encouraged to avoid jarring or high-impact activities for 1 week to promote healing of the biopsy site. Discomfort is usually minimal from the procedure and most women find acetaminophen sufficient for pain relief; however, a mild opioid may be prescribed, if needed.
Follow-up after the biopsy includes a return visit to the surgeon for discussion of the final pathology report and assessment of the healing of the biopsy site. Depending on the results of the biopsy, the nurse’s role varies. If the pathology report is negative for cancer, the nurse reviews incision care and explains what to expect as the biopsy site heals (ie, changes in sensation may occur weeks or months after the biopsy due to injury to the nerves within the breast tissue). If a diagnosis of cancer is made, the nurse’s role changes dramatically.