Definition
Breast biopsy is the removal of a sample of breast tissue or cells so that it can be tested for breast cancer.
Purposes for Breast Biopsy
- To determine the diagnosis precisely for proper treatment.
- To confirm the presence and nature of neoplastic disease.
- To rule out malignancy.
Indications
- Any suspicious lump/lesion in the breast.
- To determine if the lump detected requires surgical removal.
Types of Breast biopsy
1. Fine needle aspiration cytology (FNAC):
This is the simplest type of biopsy and may be used to evaluate a lump that can be felt during a clinical breast examination. This is less expensive and less traumatic. A 20-25 G needle isused to make multiple punctures in the lesion, and fluid containing dislodged cells is aspirated to make smears for cytological examination.
Disadvantages:
- Requires an experienced cytologist to aspirate sample and to interpret accurately.
- It has high insufficiency and false-negative rates.
- A negative FNAC cannot reliably exclude the presence of breast cancer.
- The FNAC cannot differentiate in situ from invasive cancer.
- Definitive diagnosis of a benign condition is rarely made.
2. Core needle biopsy:
Core needle biopsy (CNB) of breast is commonly performed using spring lock, automated core biopsy needle commonly known as biopsy gun. 14 G caliber is the standard size of biopsy guns for breast CNB. The needle is inserted through a small incision in the skin, and a core of tissue is removed. It is done with the assistance of mammography or ultrasound imaging.
Advantages:
- Accuracy of CNB is better than FNAC and allows cellular evaluation.
- Specific diagnosis of benign and malignant conditions can be made.
Disadvantages:
- Core needle biopsy is more traumatic and expensive and requires higher skills to perform when compared to FNAC.
3. Ultrasound-guided breast biopsy:
This type of breast biopsy uses sound waves help locate a lump or abnormality and remove a tissue sample for examination under microscope to determine a diagnosis. It is less invasive than surgical biopsy, leaves little or no scarring and does not involve exposure to ionizing radiation.
Indications:
- Suspicious solid mass.
- Distortion in the structure of the breast tissues.
- Area of abnormal tissue changes.
Articles
- Ultrasound machine with transducer (high frequency, linear type).
- Ultrasound conductive gel.
- An automated biopsy device equipped with a long needle of 23 mm with 14 G caliber.
- Scalped blade.
- 5-10 mL syringe.
- Sterile containers with 5-10 mL of 10% formalin.
- Sterile gloves and gauze pads.
- Spot light.
Procedure for Breast Biopsy
| Nursing action | Rationale | |
| 1. | Explain the procedure to patient and prepare her physically and psychologically by informing that she will: Be awake during biopsy.Experience little discomfort while injecting local anesthetic and inserting needle.Remain still while the biopsy is performed.Hear clicks or buzzing sounds from the equipment. | Promotes relaxation and cooperation while undergoing the procedure. |
| 2. | Ensure that informed consent is taken. | Avoids legal issues. |
| 3. | Ensure that all the previous reports of ultrasound, mammography, MRI and other tests are available and reviewed. | Ensures safety and accuracy. |
| 4. | Provide a patient gown and remove all jewelry. | Avoids any hindrance for procedure performance. |
| 5. | Ensure that the patient has stopped taking aspirin or anticoagulants for 3 days. | To avoid any occurrence of bleeding. |
| 6. | Position the patient supine or slightly turned to one side. | For promoting convenience to the operating professionals’ movements. |
| 7. | Perform antiseptic cleansing of a wider area around the lesion using betadine solution. | Renders the skin over the area or lesion germ free. |
| 8. | Drape the area using sterile towels. | To avoid contamination. |
| 9. | Pressing the transducer to the breast, the radiologist will locate the Finds correct location of the lesion. | Finds correct location of the lesion. |
| 10. | A small nick is made in the skin at the site where the biopsy needle is to be inserted. | Locates the right entry point for the needle. |
| 11. | Orthogonal measurements and localization of the lesion is performed. | The clock position system is used to measure the distance between the lesion and nipple. |
| 12. | Holding the transducer conveniently with one hand for ultrasound guidance, the physician injects anesthetic agent through the entire pathway up to the lesion. | Anesthetizes the area of surgical intervention. |
| 13. | The needle is inserted and advanced directly into the mass and over the entry point of the needle a 2-3 mm and an incision is made on the skin. | To facilitate passage of the biopsy needle. |
| 14. | The biopsy needle inserted through the incision is advanced directly into the mass following the same pathway. | Verifies position of the needle. |
| 15. | Guiding the needle, the nodule is penetrated and the sample retrieved. | Obtains tissue sample. |
| 16. | Place the tissue samples in the vial with formaldehyde. | Minimum of five good samples are taken from different areas of the lesion. |
| 17. | Compress the incision area for 5 minutes and apply ice over the incision site. | Controls bleeding at the incision area. |
| 18. | Apply a compressive dressing and instruct to keep it for 24 to 48 hours. | Avoids chances of bleeding. |
Postprocedural instructions for patient
- Following biopsy, if swelling and bruising develops, apply cold pack.
- Nonsteroidal anti-inflammatory drugs may be taken for 2-5 days.
- Contact the physician if she experiences excessive swelling, bleeding, drainage, redness, and heat in the breast.
- Avoid strenuous activity for 24 hours after biopsy.
Special Consideration
- Assist the patient in positioning for the specific type of biopsy (e.g., lying down for a core needle biopsy or sitting for a fine-needle aspiration).
- Observe the patient’s vital signs and comfort level throughout the procedure.
- Offer verbal reassurance and explain each step as it happens to reduce anxiety.
- Hand instruments to the physician as needed and ensure proper handling of tissue samples.
- Apply pressure to the biopsy site to minimize bleeding and cover it with a sterile dressing.
- Provide instructions for keeping the site clean and dry.
- Observe for immediate complications, such as excessive bleeding or signs of infection.
- Advise the patient to report any unusual symptoms, such as fever or persistent pain.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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