Recovery From the Procedure

The recovery period immediately following biopsy will vary depending on the extent of anesthesia and the site of the biopsy. For example, patients undergoing a more complicated biopsy may require several hours of observation before being discharged. Patients and caregivers should be educated about what to expect immediately following the procedure, including approximately how long they will be at the center where the procedure is performed, how long it may be before the patient is able to function independently, and any limitations that could be placed on the patient’s activity.

Potential complications following biopsy vary as well. Patients and caregivers should understand what complications are normal and should be expected, and what postprocedure signs or symptoms may require provider follow-up.

Common potential complications following biopsy include discomfort, bruising, and/or bleeding at the biopsy site.10 A study of 351 women who underwent image-guided breast biopsy found that postbiopsy pain was mild, with a mean score of 2.3 with ultrasound-guided biopsy and 3.1 with vacuum-assisted stereotactic biopsy (both out of 10).11 The level of physician experience, but not the needle gauge or number of biopsy cores performed, was associated with pain.

Related Articles

Patients who underwent stereotactic biopsy reported more discomfort and pain from body position compared with those who underwent ultrasound-guided biopsy (28% vs 0.4%, respectively). In a study of 274 patients who underwent ultrasound-guided biopsy of the liver or pancreas, the mean pain level (out of a maximum of 10) was 2.98 at the time of puncture, 1.21 at 1 hour, and 0.71 after 4 hours.12 A higher level of pain at puncture and at 1 hour was associated with female sex and younger age (< 50 years). A study of more than 900 men who underwent transrectal ultrasound-guided biopsy found that 44% reported pain within 35 days after biopsy, though only 7% reported the pain as a major or moderate problem.13

Patients should be educated about potential bleeding, bruising, and swelling after biopsy, because these symptoms can cause anxiety.14 For example, the study of prostate biopsy found that 93%, 66%, and 37% experienced hemoejaculate, hematuria, or hematochezia, respectively.13 In another study of 1147 men who underwent prostate biopsy, a greater level of anxiety was reported among those who experienced symptoms such as pain, hematuria, hematochezia, and hemoejaculate within 7 days after biopsy.14

Patients should also be aware of rare, but potentially serious, complications such as infection or damage to nearby tissue/structures.10

Biopsy Results

Most patients, understandably, want their biopsy results as quickly as possible. A multicenter study of 301 patients who underwent biopsy for potential melanoma found that 52% of patients wanted their results via a rapid method, such as a telephone call, voice message, email, or online portal.15 If the results were abnormal, nearly 70% of patients preferred a telephone call, followed by approximately 28% requesting a face-to-face meeting. For patients with normal results, about 32% reported that a voice message was acceptable, followed by approximately 28% and 24% indicating they preferred email or a telephone call, respectively. The online portal was favored by younger patients and by those who had a higher level of education.

Although most patients prefer to receive their results rapidly, some may prefer a face-to-face meeting. This should be discussed and decided prior to the biopsy.16 For patients who prefer a rapid method for receiving results, the news should be delivered with compassion.

References

  1. Miller SJ, Sohl SJ, Schnur JB, et al. Pre-biopsy psychological factors predict patient biopsy experience. Int J Behav Med. 2014;21(1):144-148.
  2. Soo AE, Shelby RA, Miller LS, et al. Predictors of pain experienced by women during percutaneous imaging-guided breast biopsies. J Am Coll Radiol. 2014;11(7):709-716.
  3. Miller LS, Shelby RA, Balmadrid MH, et al. Patient anxiety before and immediately after imaging-guided breast biopsy procedures: impact of radiologist-patient communication. J Am Coll Radiol. 2013;10(6):423-431.
  4. Mayo Clinic Staff. Biopsy: Types of biopsy procedures used to diagnose cancer. Mayo Clinic. www.mayoclinic.org/diseases-conditions/cancer/in-depth/biopsy/art-20043922?p=1. Published December 17, 2016. Accessed September 28, 2018.
  5. Volanis D, Neal DE, Warren AY, Gnanapragasam VJ. Incidence of needle-tract seeding following prostate biopsy for suspected cancer: a review of the literature. BJU Int. 2015;115(5):698-704.
  6. Minaga K, Takenaka M, Katanuma A, et al. Needle tract seeding: an overlooked rare complication of endoscopic ultrasound-guided fine-needle aspiration. Oncology. 2017;93(suppl):107-112.
  7. Shah KS, Ethunandan M. Tumour seeding after fine-needle aspiration and core biopsy of the head and neck — a systematic review. Br J Oral Maxillofac Surg. 2016;54(3):260-265.
  8. Silva MA, Hegab B, Hyde C, Guo B, Buckels JA, Mirza DF. Needle track seeding following biopsy of liver lesions in the diagnosis of hepatocellular cancer: a systematic review and meta-analysis. Gut. 2008;57(11):1592-1596.
  9. Loughran CF, Keeling CR. Seeding of tumour cells following breast biopsy: a literature review. Br J Radiol. 2011;84(1006):869-874.
  10. Informed Health Online [Internet]. What happens during a biopsy? Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG). https://www.ncbi.nlm.nih.gov/books/NBK348942/. Updated February 10, 2016. Accessed September 28, 2018.
  11. Seely JM, Hill F, Peddle S, Lau J. An evaluation of patient experience during percutaneous breast biopsy. Eur Radiol. 2017;27(11):4804-4811.
  12. Lindner A, Frieser M, Heide R, et al. Postinterventional pain and complications of sonographically guided interventions in the liver and pancreas. Ultraschall Med. 2014;35(2):159-165.
  13. Rosario DJ, Lane JA, Metcalfe C, et al. Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study. BMJ. 2012;344:d7894.
  14. Wade J, Rosario DJ, Macefield RC, et al. Psychological impact of prostate biopsy: physical symptoms, anxiety, and depression. J Clin Oncol. 2013;31(33):4235-4241.
  15. Choudhry A, Hong J, Chong K, et al. Patients’ preferences for biopsy result notification in an era of electronic messaging methods. JAMA Dermatol. 2015;151(5):513-520.
  16. Susan F. Informing the patient of a test result. Cure. www.curetoday.com/community/susan-f/2015/10/informing-the-patient-of-a-test-result. Published October 2015. Accessed October 1, 2018.