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A breast biopsy is the surgical removal of breast tissue for histopathological analysis, usually in the setting of suspicious findings discovered on mammography or ultrasonography. This procedure can take many forms, including fine-needle aspiration cytology (FNA), core needle biopsy, open breast biopsy, excisional biopsy, and lumpectomy, and may be associated with sentinal lymph node biopsy.   
A breast biopsy is the surgical removal of breast tissue for histopathological analysis, usually in the setting of suspicious findings discovered on mammography or ultrasonography. This procedure can take many forms, including fine-needle aspiration cytology (FNA), core needle biopsy, open breast biopsy, excisional biopsy, and lumpectomy, and may be associated with sentinel lymph node biopsy. <ref>{{Cite book|url=https://www.worldcat.org/oclc/888551588|title=Anesthesiologist's manual of surgical procedures|date=2014|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu|isbn=978-1-4963-0594-7|edition=Fifth edition|location=Philadelphia|oclc=888551588}}</ref>  


== Preoperative management ==
== Preoperative management ==
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=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===


=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
* Only as indicated from H&P


=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===


=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
* Can be a high-anxiety procedure, consider midazolam
* Consider scopolamine patch in young women at high risk for PONV


== Intraoperative management ==
== Intraoperative management ==


=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
* Standard ASA monitors
* 18-20G PIV x 1


=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
* Natural airway for procedures that can be done under local +/- sedation including FNA, core needle biospy
* LMA vs. ETT for deeper lesions, resections, and sentinel node biopsies


=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
* Supine with ipsilateral arm abducted
* Table may be airplaned to center breast


=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
* Standard maintenance, muscle relaxants often not required


=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
* No special considerations


== Postoperative management ==
== Postoperative management ==


=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
* PACU > home


=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
* Pain score 2-5
* PO analgesics


=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
* Hematoma formation
* Infection
* Seeding of tumor to other sites


== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
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Revision as of 16:54, 30 April 2021

Breast biopsy
Anesthesia type

Depends on size of lesion, depth of lesion, and amount of tissue to be sampled. Includes local, local with IV sedation, or GA.

Airway

Natural airway, LMA or ETT

Lines and access

PIV 18-20G x 1 if sedation is to be used

Monitors

Standard monitors

Primary anesthetic considerations
Preoperative

Patients with previous history of breast cancer may have had prior lymph node involvement and one arm may be unavailable for lines

Intraoperative
Postoperative

Urine, emesis or stool may be blue for 24-48h if dye is injected

Article quality
Editor rating
In development
User likes
0

A breast biopsy is the surgical removal of breast tissue for histopathological analysis, usually in the setting of suspicious findings discovered on mammography or ultrasonography. This procedure can take many forms, including fine-needle aspiration cytology (FNA), core needle biopsy, open breast biopsy, excisional biopsy, and lumpectomy, and may be associated with sentinel lymph node biopsy. [1]

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular
Respiratory
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

  • Only as indicated from H&P

Patient preparation and premedication

  • Can be a high-anxiety procedure, consider midazolam
  • Consider scopolamine patch in young women at high risk for PONV

Intraoperative management

Monitoring and access

  • Standard ASA monitors
  • 18-20G PIV x 1

Induction and airway management

  • Natural airway for procedures that can be done under local +/- sedation including FNA, core needle biospy
  • LMA vs. ETT for deeper lesions, resections, and sentinel node biopsies

Positioning

  • Supine with ipsilateral arm abducted
  • Table may be airplaned to center breast

Maintenance and surgical considerations

  • Standard maintenance, muscle relaxants often not required

Emergence

  • No special considerations

Postoperative management

Disposition

  • PACU > home

Pain management

  • Pain score 2-5
  • PO analgesics

Potential complications

  • Hematoma formation
  • Infection
  • Seeding of tumor to other sites

Procedure variants

FNA/Core Needle Biopsy Open Breast Biopsy Lumpectomy/Excisional Biospy
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References

  1. ↑ Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (Fifth edition ed.). Philadelphia. 2014. ISBN 978-1-4963-0594-7. OCLC 888551588. |edition= has extra text (help)CS1 maint: others (link)

Top contributors: Olivia Sutton and Chris Rishel

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