Purpose: Axillary core needle biopsy (CNB) is perceived as higher risk for bleeding than breast CNB and patients’ antithrombotic (AT) therapy is commonly discontinued for biopsy. This study aims to compare the frequency of bleeding events following axillary CNB between patients without AT therapy use, patients temporarily discontinuing AT therapy, and patients continued on AT therapy during biopsy.
Materials and Methods: This retrospective study included 165 axillary biopsies in 155 patients (median age, 54) performed at the study institution from January 1, 2014, to December 31, 2020. Up to December 31, 2016, institutional policy required patients temporarily discontinue AT therapy 5 days prior to axillary CNB. Institutional policy changed on January 1st, 2017, allowing patients to continue AT therapy during CNB. Patients were called 24-48 hours after biopsy and screened for palpable hematoma and bruising. Post biopsy mammograms were obtained immediately after biopsy and reviewed for imaging-apparent hematoma. The EMR was screened for clinically significant post biopsy hematoma defined as hematomas requiring drainage, primary care or emergency department visit, or hospital admission. Bleeding events were compared among groups.
Results: 132 biopsies were obtained in patients not on AT, 8 in patients who temporarily discontinued AT therapy, and 25 in patients who continued AT therapy during axillary CNB. Three patients developed imaging-apparent hematoma occurring in 0.8% (1/132) of patients not on AT, 8% (2/25) of patients that continued AT therapy, and in no patients who temporarily discontinued AT therapy (p = .70 discontinued vs. continued AT therapy). Axillary bruise developed after 3% (4/132) of biopsies in patients not on AT and in no patients who continued or temporarily discontinued AT therapy. Biopsies performed with an 18-gauge needle were associated with decreased odds of bruising when compared to biopsies performed with a 14-gauge needle (OR = 0.14, 95% CI: 0.02;0.98, p = 0.05), but not significantly associated with odds of hematoma formation (OR=0.25, CI 95%: 0.03;2.86 , p=0.23). Neither number of samples, nor pathology were associated with increased OR of bleeding. No patient developed palpable hematoma or clinically significant hematoma.
Conclusion: Imaging-apparent and palpable hematoma is a rare complication of axillary CNB even for patients on AT. There is no significant difference in frequency of imaging-apparent hematoma between patients who continued versus discontinued AT therapy during axillary CNB.
Clinical Relevance Statement: The findings of this study demonstrate the overall low risk of hematoma formation following axillary core needle biopsy supporting the safety of continuing antithrombotic therapy during axillary core needle biopsy.
