E2523. Management of Bleeding Complications After Image Guided Breast Biopsy: A Case-Based Review
  1. Miral Patel; University of Texas MD Anderson Cancer Center
  2. Christina Checka; University of Texas MD Anderson Cancer Center
  3. Emily Nia; University of Texas MD Anderson Cancer Center
  4. Megha Kapoor; University of Texas MD Anderson Cancer Center
  5. Mary Guirguis; University of Texas MD Anderson Cancer Center
  6. Laila Khazai; University of Texas MD Anderson Cancer Center
  7. Beatriz Adrada; University of Texas MD Anderson Cancer Center
Image-guided breast biopsy includes mammographic-guided procedures such as stereotactic and tomography-guided biopsy, biopsy under sonographic control, and MRI-guided biopsy. Although imaging guidance allows for precise targeting of suspicious lesions, it is not always possible to detect or avoid blood vessels that may be inadvertently divided or punctured during as the introducer needle traverses the breast tissue. Bleeding complications may be acute (noted during or immediately following the procedure) or subacute (starting after the procedure). In addition, hematoma formation may affect subsequent localization for anticipated breast surgery. The purpose of this educational exhibit is to provide a case-based review for radiologists in management of bleeding complications after image-guided breast biopsy.

Educational Goals / Teaching Points
This educational exhibit's goals are as follows: 1) Provide case based examples of biopsies resulting in acute or subacute bleeding. 2) Explore options for controlling bleeding complications including immediate postprocedural options in the biopsy suite, compression techniques, suturing and skin closure techniques, and also review unconventional methods described in the literature. 3) Demonstrate how hematomas can affect subsequent breast surgery.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
There are many articles discussing anticoagulation and the risk of bleeding during image-guided breast biopsies, but few articles outlining management options of this complication for radiologists. This exhibit provides resources for radiologists who encounter bleeding complications when performing image-guided breast biopsies.

Informed consent for image-directed breast biopsy requires a discussion regarding possible complications, including hematoma. Clinical priorities include acute management (assurance of hemodynamic stability), patient education about expected symptoms, and considerations for subsequent preoperative localization for breast surgery. Having a repertoire of possible solutions to manage bleeding complications results in an improved experience for the patient. In the acute setting, solutions may include conventional methods such as manual aspiration of the hematoma with the addition of various skin closure techniques. If a hematoma reaccumulates, patients should be advised that secondary ecchymosis can be expected (either due to manual manipulation of the tissue or tracking of blood into the dependent tissues). Due to the protein-rich nature of the hematoma and the skin nick, patients should also be educated about signs and symptoms of secondary infection that should be reported to the clinical team. Patients should be advised that full resolution of hematoma symptoms may take several weeks. Lastly, clips should be reevaluated for migration before final surgical planning, and this should be communicated to the surgical and pathology teams.