Background

For image-guided core-needle breast biopsy (CNBB), it remains unclear whether antithrombotic medication should be withheld because of hematoma risk.

Purpose

To determine hematoma risk after CNBB in patients receiving antithrombotic medication and to stratify risk by antithrombotic type.

Materials and Methods

This HIPAA-compliant retrospective study included US-, stereotactic-, or MRI-guided CNBBs performed across six academic and six private practices between April 2019 and April 2021. Patients were instructed to continue antithrombotic medications, forming two groups: antithrombotic and nonantithrombotic. Hematomas were defined as new biopsy-site masses with a diameter of 2 cm or larger on postprocedure mammograms. Hematomas were considered clinically significant if management involved an intervention other than manual compression. Patient age, type of antithrombotic medication, practice type, image guidance modality, needle gauge and type, and outcome of pathologic analysis were recorded. Multivariable logistic regression analysis was used to analyze variables associated with hematomas.

Results

A total of 3311 biopsies were performed in 2664 patients (median age, 60 years; IQR, 48–70 years; 2658 women). The nonantithrombotic group included 2788 biopsies, and the antithrombotic group included 523 biopsies (328 low-dose aspirin, 73 full-dose antiplatelet drugs, 51 direct oral anticoagulants, 36 warfarin, 32 daily nonsteroidal anti-inflammatory drugs, three heparin or enoxaparin). The antithrombotic group had a higher overall hematoma rate (antithrombotic group: 49 of 523 biopsies [9.4%], nonantithrombotic group: 172 of 2788 biopsies [6.2%]; P = .007), but clinically significant hematoma rates were not different (antithrombotic group: two of 523 biopsies [0.4%], nonantithrombotic group: one of 2788 biopsies [0.04%]; P = .07). At multivariable analysis, age (odds ratio [OR], 1.02; 95% CI: 1.01, 1.03; P < .001), 9-gauge or larger needles (OR, 2.1; 95% CI: 1.28, 3.3; P = .003), and full-dose antiplatelet drugs (OR, 2.5; 95% CI: 1.29, 5.0; P = .007) were associated with higher hematoma rates. US guidance (OR, 0.26; 95% CI: 0.17, 0.40; P < .001) and 10–14-gauge needles (OR, 0.53; 95% CI: 0.36, 0.79; P = .002) were predictive of no hematoma.

Conclusion

Because clinically significant hematomas were uncommon, withholding antithrombotic medications before core-needle breast biopsy may be unnecessary. Postbiopsy hematomas were associated with full-dose antiplatelet drugs, patient age, and 9-gauge or larger needles. No association was found with other types of antithrombotic medication.

© RSNA, 2022

Online supplemental material is available for this article.

See also the editorial by Chang and Yoen in this issue.

中文翻译：

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图像引导核心针乳房活检期间的抗血栓治疗和血肿风险

背景

对于图像引导空芯针乳腺活检 (CNBB)，尚不清楚是否应因血肿风险而停止使用抗血栓药物。

目的

确定接受抗血栓药物治疗的患者 CNBB 后血肿风险，并按抗血栓类型对风险进行分层。

材料和方法

这项符合 HIPAA 标准的回顾性研究包括在 2019 年 4 月至 2021 年 4 月期间在六家学术诊所和六家私人诊所进行的美国、立体定向或 MRI 引导的 CNBBs。患者被指示继续服用抗血栓药物，分为两组：抗血栓组和非抗血栓组。血肿被定义为术后乳房 X 线照片上直径为 2 cm 或更大的新活检部位肿块。如果管理涉及手动压缩以外的干预，则血肿被认为具有临床意义。记录患者年龄、抗血栓药物类型、实践类型、图像引导方式、针头规格和类型以及病理分析结果。多变量逻辑回归分析用于分析与血肿相关的变量。

结果

共对 2664 名患者（中位年龄 60 岁；IQR，48-70 岁；2658 名女性）进行了 3311 次活检。非抗血栓组包括 2788 个活检，抗血栓组包括 523 个活检（328 个低剂量阿司匹林，73 个全剂量抗血小板药物，51 个直接口服抗凝剂，36 个华法林，32 个每日非甾体抗炎药，3 个肝素或依诺肝素）。抗血栓组总体血肿率较高（抗血栓组：523 例活检中有 49 例 [9.4%]，非抗血栓组：2788 例活检中有 172 例 [6.2%]；P = .007），但临床显着血肿率没有差异（抗血栓组：523 个活检中的两个 [0.4%]，非抗血栓组：2788 个活检中的一个 [0.04%]；P=.07）。在多变量分析中，年龄（比值比 [OR]，1.02；95% CI：1.01、1.03；P < .001）、9 号或更大的针头（OR，2.1；95% CI：1.28、3.3；P = . 003) 和全剂量抗血小板药物 (OR, 2.5; 95% CI: 1.29, 5.0; P = .007) 与较高的血肿发生率相关。US 指导（OR，0.26；95% CI：0.17、0.40；P < .001）和 10-14 号针头（OR，0.53；95% CI：0.36、0.79；P = .002）预测无血肿.

结论

由于临床上显着的血肿并不常见，因此在空芯针乳房活检之前停止使用抗血栓药物可能是不必要的。活检后血肿与全剂量抗血小板药物、患者年龄和 9 号或更大的针头有关。未发现与其他类型的抗血栓药物有关联。

©北美放射学会，2022

本文提供了在线补充材料。

另见本期 Chang 和 Yoen 的社论。