Unusual Presentation of a Post-procedural Breast Hematoma: A Case Report

Abstract

Background/Aim: Hematoma is the most frequent complication after Vacuum-Assisted Breast Biopsy (VABB) in 13% of cases. A direct communication channel with patients eases the diagnosis of VABB complications and ensures treatment at an early stage, as outpatients, in most cases. In 2020, due to the COVID-19 pandemic, we observed a reduction of self-reported postoperative complication leading to delay in the identification of harmful complications, therefore leading to need for more invasive treatment. Case Report: A 50-year-old patient was admitted to the Emergency Department for dry cough, fever, chest discomfort, dyspnea, and slight confusion four days after VABB. Due to the reported symptoms, the patient was sent to our COVID-19 Emergency Department. The COVID-19 swab was negative. Ultrasound revealed a large hematoma at the biopsy site, with active bleeding. Open evacuation with accurate hemostasis was planned with rapid and complete resolution of the clinical symptoms. After surgery, the patient reported that she intentionally avoided admittance in the hospital due to the risk of COVID-19 infection. The patient was discharged in the first postoperative day and maintained in quarantine for 14 days. Conclusion: In the COVID-19 era due to the risk of hospital cross-infections, reduction of patientdoctor communication could lead to misdiagnosis, delay in recognition of procedural complications thus leading to requirement for invasive treatment, hospitalization, while also further multiplying the risk of COVID-19 infection.Breast Cancer (BC) represents the most common neoplasia worldwide, affecting more than 2.3 million women yearly (1). Patient tailored treatment encompasses a combination of surgery, medical, and radiation oncology treatment (2-4). Keeping in mind the complexity of BC treatment options, careful diagnostic assessment is imperative to choose for the best treatment strategy for each patient to reduce locoregional (5-7) and distant relapse (8,9). Diagnostic assessment requires a complete clinical evaluation, so called triple assessment, which includes physical examination, imaging (mammography and/or ultrasound), and needle biopsy [fine needle aspiration cytology (FNAC), core needle biopsy (CNB), or vacuumassisted breast biopsy (VABB)] (10).Among different needle biopsy procedures, VABB gained popularity thanks to the achievement of bigger sampling within a single insertion and lower rate of false-negative results (11,12). Moreover, VABB procedure allows the complete removal of small benign lesions, especially when smaller than 10 mm (13), representing a safe technique with a low rate of major complications (2.1%) even when performed with larger needles (8 or 11 Gauge) (14,15). Most common minor complication are represented by hematoma, with an incidence of 13% (16).In order to identify any early VABB complication, most of the BC Centre facilities developed a telephonic direct communication system between health care providers and patients (17). In our experience, the direct communication system provi...

Vascular Complications following Vacuum-Assisted Breast Biopsy (VABB): A Case Report and Review of the Literature

“…Vanni G. et al [ 29 ] reported a patient who was admitted to the Emergency Department for a worsening dry cough, fever (37.5 °C), chest discomfort, feelings of pressure associated with shortness of breath, fatigue, and slight confusion and had undergone a VABB of the left breast four days earlier as a monitoring measure due to a microcalcification cluster localized at the external-superior quadrant.…”

Socioeconomic Impact of OncotypeDX on Breast Cancer Treatment: Preliminary Results

“…In the past decade, the classification of BC molecular subtypes has emerged as a significant breakthrough in tumor assessment and management, providing clinicians with a valuable tool to shift adjuvant treatment decisions from relying solely on statistical risk to incorporating predictive biomarker assessment (5). BC distant disease spread is the result of a not fully understood complex interplay between biological processes, including tumor circulation, proliferation, angiogenesis, and the microenvironment of the target tissue (6)(7)(8). Although progress has been made, many questions remain unsolved in this area (9)(10)(11).…”