Breast Biopsy

Definition

Breast biopsy is necessary to confirm or rule out cancer. Needle biopsy or fine-needle biopsy can provide a core of tissue or a fluid aspirate, but needle biopsy should be restricted to fluid-filled cysts and advanced malignant lesions. Both methods have limited diagnostic value because of the small and perhaps unrepresentative specimens they provide. Open biopsy provides a complete tissue specimen, which can be sectioned to allow more accurate evaluation.

A breast biopsy can usually be done on an outpatient basis under local anesthesia; however, an excisional open biopsy may require general anesthesia. In sufficient tissue is obtained and the mass is found to be a malignant tumor, specimens are sent for estrogen and progesterone receptor assays to assist in determining future therapy and the prognosis.

Purpose

• To differentiate between benign and malignant breast tumors.

Procedure

Patient Preparation

1. Make sure the patient has signed a consent form.
2. Note and report all allergies.
3. If the patient is to receive a local anesthesia, tell her she need not restrict food or fluids.
4. If the patient is to have a general anesthesia, tell her she is to have nothing by mouth after midnight or before the procedure.
5. Obtain and report abnormal results of prebiopsy studies, such as blood tests, urine tests, and radiographs of the chest.
6. Explain that the test takes 15 to 30 minutes.

Implementation

Needle Biopsy

1. Instruct your patient to undress to the waist.
2. After guiding her to a sitting or recumbent position with her hands at her sides, tell her to remain still.
3. The doctor then prepares the biopsy site, administers a local anesthetic, and introduces the syringe (luer-lock syringe for aspiration, Vim-Silverman needle for tissue specimen) into the lesion.
4. Fluid aspirated from the breast is expelled into a properly labeled, heparinized tube; the tissue specimen is placed in a labeled specimen bottle containing normal saline solution or formalin.
5. Send both specimens to the laboratory immediately. (With fine needle aspiration, a slide is made and viewed immediately under a microscope).
6. Because breast fluid aspiration isn’t diagnostically accurate, some doctors aspirate fluid only from cysts. If such fluid is clear yellow and the mass disappears, the aspiration is both diagnostic and therapeutic, and the aspirate is discarded. If aspiration yields no fluid or if the lesion recurs two or three times, an open biopsy is then considered appropriate.
7. After the procedure, pressure is exerted on the biopsy site and, after bleeding has stopped, an adhesive bandage is applied.

 Open Biopsy

1. The site is prepared and draped, and the patient is given a local or general anesthetic.
2. An incision is made in the breast to expose the mass. A portion of tissue or the entire mass is extracted.
3. Benign-appearing masses smaller than ¾” (2cm) in diameter are usually excised.
4. The specimens are placed in properly labeled specimen bottles containing 10% formalin solution.
5. The malignant-appearing tissue is sent for frozen suction and receptor assays.

Nursing Interventions

1. If the patient has received a general or local anesthetic, monitor the patient’s vital signs regularly. If she has received a general anesthetic, check her vital signs every 15 minutes for 1 hour, every 30 minutes for 2 hours, every hour for the next 4 hours, and then every 4 hours.
2. Administer analgesics for pain, as ordered, and provide ice bags for comfort.
3. Instruct the patient to wear a support bra at all times until healing is complete.
4. Observe for and report bleeding, tenderness, and redness at the biopsy site.
5. Provide emotional support to the patient awaiting diagnosis.

Interpretation

Normal Results

1. Breast tissue consists of cellular and noncellular connective tissue, fat lobules, and various lactiferous ducts.
2. Breast tissue is pink, more fatty than fibrous, and shows no abnormal development of cells or tissue elements.

Abnormal Results

1. Benign tumors may suggest fibrocystic disease, adenofibroma, intraductal papilloma, mammary fat necrosis, or plasma cell mastitis.
2. Malignant tumors may suggest adenocarcinoma, cystosarcoma, intraductal and infiltrating carcinoma, inflammatory carcinoma, medullary or circumscribed carcinoma, colloid carcinoma, lobular carcinoma, sarcoma, or Paget’s disease.

Precaution

• Breast biopsy is contraindicated in the patient with a condition that precludes surgery.

Interfering Factors

• Failure to obtain an adequate tissue specimen or to place the specimen in the proper solution container interfering with test results.

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