AJR: Complications rates are low with core-needle biopsies

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CT scan shows a biopsy needle advanced between the lateral edge of the sternum and the internal mammary vessels for biopsy. Image source: Radiographics

The overall incidence of major bleeding after imaging-guided percutaneous core-needle biopsy is low, and recent aspirin therapy does not appear to significantly increase the risk of such bleeding complications, according to a retrospective study in the March issue of the American Journal of Roentgenology.

“With the evolution of imaging guidance, percutaneous biopsy has become a valuable tool in obtaining tissue for diagnosis,” said lead author Thomas D. Atwell, MD, from the department of radiology at the Mayo Clinic in Rochester, Minn. “Unfortunately, this procedure is not without risk, and hemorrhage is the most feared complication after biopsy.”

The researchers said the objective of their study was to report the incidence of bleeding after imaging-guided percutaneous core biopsy at a single center using a standardized technique.

Atwells and colleagues performed a retrospective review of percutaneous core biopsies performed at Mayo from January 2002 through February 2008. They collected data at the time of biopsy and obtained clinical information at 24 hours and three months after the biopsy. The specific information that was collected included the results of coagulation studies, aspirin use, the organ biopsied, the size of the biopsy needle and the number of needle passes. They defined bleeding complications using the Common Terminology Criteria for Adverse Events established by the National Cancer Institute.

Among the 15,181 percutaneous core biopsies performed during the study period, 70 hemorrhages (0.5 percent) that were CTCAE grade 3 or greater were identified within three months of biopsy, according to the authors. The incidence of bleeding in patients taking aspirin within 10 days before biopsy was 0.6 percent, which was not statistically different compared with the incidence of bleeding in those not taking aspirin (0.4 percent).

The researchers found that the incidence of bleeding after liver biopsy was 0.5 percent; kidney biopsy, 0.7 percent; lung biopsy, 0.2 percent; pancreas biopsy, 1 percent; and other biopsy, 0.2 percent.

According to the authors, there were significant associations between major bleeding and serum platelet count and international normalized ratio, although the association between major bleeding and the size of the biopsy needle was not significant.

“Significant bleeding after percutaneous biopsy is exceptionally rare. In most cases, percutaneous biopsy can be performed in patients with recent aspirin use. In those patients undergoing elective, nonurgent deep organ biopsy, scheduling the biopsy 10 days after the last dose of aspirin is a reasonable, but not a necessary, precaution,” Atwells said.