Introduction: Pre-therapeutic histologic diagnosis through image-guided core needle biopsy (CNB) or vacuum-assisted biopsy (VAB) for suspicious breast findings is a standard procedure. Despite the moderate risk of bleeding, a significant proportion of patients are on temporary or permanent anti-coagulation therapy (ACT) or anti-platelet therapy (APT). Currently, there are no established guidelines for managing biopsies in such patients, leading to varying approaches in clinical practice. Methods: An online survey was conducted among all members of the breast ultrasound working group at the German Society for Ultrasound in Medicine (DEGUM) and the working group for breast diagnostics at the German Radiology Society (DRG). It included n = 51 questions about individual risk perception of biopsy-related bleeding complications and the specific management of biopsies on ACT/APT. Results: A total of 332 experts participated, with 51.8% reporting the absence of a standardized management plan for breast biopsies on ACT/APT. Concerning specific ACT/APT medications, the survey revealed discrepancies in risk perception and management: The majority preferred discontinuing medication with directly acting oral anti-coagulants (DOACs; CNB: 66.9%; VAB: 91.1%), phenprocoumon (CNB: 74.9%; VAB: 96.7%), or therapeutic heparin (CNB: 46.1%; VAB: 72.7%). However, there was a lower inclination to discontinue acetylsalicylic acid (ASA; CNB: 15.2%; VAB: 50.3%) or prophylactic heparin (CNB: 11.9%, VAB: 36.3%). Conclusion: Breast biopsies for patients on ASA or prophylactic heparin are deemed safe and part of standard clinical practice. However, despite available feasibility studies, conducting breast biopsies on ACT medications such as DOACs or phenprocoumon appears feasible only for a minority of experts.

1.
Wöckel
A
,
Festl
J
,
Stuber
T
,
Brust
K
,
Stangl
S
,
Heuschmann
PU
, et al
.
Interdisciplinary screening, diagnosis, therapy and follow-up of breast cancer. Guideline of the DGGG and the DKG (S3-level, AWMF registry number 032/045ol, december 2017) - Part 1 with recommendations for the screening, diagnosis and therapy of breast cancer
.
Geburtshilfe Frauenheilkd
.
2018
;
78
(
10
):
927
48
.
2.
Ditsch
N
,
Kolberg-Liedtke
C
,
Friedrich
M
,
Jackisch
C
,
Albert
US
,
Banys-Paluchowski
M
, et al
.
AGO recommendations for the diagnosis and treatment of patients with early breast cancer: update 2021
.
Breast Care
.
2021
;
16
(
3
):
214
27
.
3.
Bruening
W
,
Fontanarosa
J
,
Tipton
K
,
Treadwell
JR
,
Launders
J
,
Schoelles
K
.
Systematic review: comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions
.
Ann Intern Med
.
2010
;
152
(
4
):
238
46
.
4.
Lin
LLY
,
Gao
Y
,
Lewin
AA
,
Toth
HK
,
Heller
SL
,
Moy
L
.
Overstated harms of breast cancer screening? A large outcomes analysis of complications associated with 9-gauge stereotactic vacuum-assisted breast biopsy
.
Am J Roentgenol
.
2019
;
212
(
4
):
925
32
.
5.
Bick
U
,
Trimboli
RM
,
Athanasiou
A
,
Balleyguier
C
,
Baltzer
PAT
,
Bernathova
M
, et al
.
Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging
.
Insights Imaging
.
2020
;
11
(
1
):
12
.
6.
Harbrecht
U
.
Old and new anticoagulants
.
Hamostaseologie
.
2011
;
31
(
1
):
21
7
.
7.
Godfrey
EM
,
Godfrey
AL
,
Perry
DJ
,
Shaw
AS
.
Don’t be a clot: a radiologist’s guide to haemostasis including novel antiplatelet and anticoagulant therapies
.
Clin Radiol
.
2011
;
66
(
8
):
693
700
.
8.
Kirchhof
P
,
Benussi
S
,
Kotecha
D
,
Ahlsson
A
,
Atar
D
,
Casadei
B
, et al
.
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
.
Eur Heart J
.
2016
;
37
(
38
):
2893
962
.
9.
Rechenmacher
SJ
,
Fang
JC
.
Bridging anticoagulation: primum non nocere
.
J Am Coll Cardiol
.
2015
;
66
(
12
):
1392
403
.
10.
British Society of Breast Radiology Guidelines
:
Protocol for breast biopsy in patients taking anticoagulant and antiplatelet therapy
. Version 2018. https://breastradiology.org/media/1022/bsbr-anticoag-guidelines-august-2018.pdf (last access: June 1, 2022).
11.
Kulkarni
T
,
O'Connor
A
.
Breast biopsy in patients on anti-coagulants: is new guidance needed
.
Breast Cancer Res
.
2015
;
17
(
S1
):
P33
.
12.
Patel
IJ
,
Davidson
JC
,
Nikolic
B
,
Salazar
GM
,
Schwartzberg
MS
,
Walker
TG
, et al
.
Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions
.
J Vasc Interv Radiol
.
2012
;
23
(
6
):
727
36
.
13.
McMahon
P
,
Reichman
M
,
Dodelzon
K
.
Bleeding risk after percutaneous breast needle biopsy in patients on anticoagulation therapy
.
Clin Imaging
.
2021
;
70
:
114
7
.
14.
Heil
J
,
Hug
S
,
Martiny
H
,
Golatta
M
,
Feisst
M
,
Madjar
H
, et al
.
Standards of hygiene for ultrasound-guided core cut biopsies of the breast
.
Ultraschall Med
.
2018
;
39
(
6
):
636
42
.
15.
Burbank
F
.
Stereotactic breast biopsy: comparison of 14- and 11-gauge Mammotome probe performance and complication rates
.
Am Surg
.
1997
;
63
(
11
):
988
95
.
16.
Parker
SH
,
Klaus
AJ
.
Performing a breast biopsy with a directional, vacuum-assisted biopsy instrument
.
Radiographics
.
1997
;
17
(
5
):
1233
52
.
17.
Liberman
L
.
Centennial dissertation. Percutaneous imaging-guided core breast biopsy: state of the art at the millennium
.
Am J Roentgenol
.
2000
;
174
(
5
):
1191
9
.
18.
Melotti
MK
,
Berg
WA
.
Core needle breast biopsy in patients undergoing anticoagulation therapy: preliminary results
.
Am J Roentgenol
.
2000
;
174
(
1
):
245
9
.
19.
Somerville
P
,
Seifert
PJ
,
Destounis
SV
,
Murphy
PF
,
Young
W
.
Anticoagulation and bleeding risk after core needle biopsy
.
Am J Roentgenol
.
2008
;
191
(
4
):
1194
7
.
20.
Chetlen
AL
,
Kasales
C
,
Mack
J
,
Schetter
S
,
Zhu
J
.
Hematoma formation during breast core needle biopsy in women taking antithrombotic therapy
.
Am J Roentgenol
.
2013
;
201
(
1
):
215
22
.
21.
Cameron
P
,
Lesko
J
,
London
MR
.
Antithrombotic therapy: evaluation of the safety of performing core needle biopsy of the breast without suspending medication
.
Clin J Oncol Nurs
.
2018
;
22
(
1
):
E18
e22
.
22.
Ashkar
LK
,
Hafiz
RM
.
Costly coagulation profile tests prior to performing breast biopsies. Do we really need it
.
Saudi Med J
.
2016
;
37
(
6
):
638
40
.
23.
Cuevas
MV
,
Martínez-Sancho
I
,
Arribas
J
,
García-Díaz
C
,
Cuevas
B
.
Cost of incorrect application of antithrombotic prophylaxis prior to invasive procedures
.
BMC Health Serv Res
.
2019
;
19
(
1
):
802
.
24.
Pritchard
MG
,
Townend
JN
,
Lester
WA
,
England
DW
,
Kearins
O
,
Bradley
SA
.
Management of patients taking antiplatelet or anticoagulant medication requiring invasive breast procedures: United Kingdom survey of radiologists’ and surgeons’ current practice
.
Clin Radiol
.
2008
;
63
(
3
):
305
11
.
You do not currently have access to this content.