Epinephrine-Containing Lidocaine and Hematoma Risk After Image-Guided Core-Needle Breast Biopsy

Abstract

Objective: To evaluate the risk of symptomatic hematomas in patients receiving epinephrine-containing lidocaine compared with lidocaine alone after core-needle breast biopsies (CNBBs). The efficacy of epinephrine-containing lidocaine in reducing hematoma risk following image-guided CNBB remains unclear.

Methods: A single-institution, retrospective review of all CNBBs performed during a 6-month period using lidocaine alone (September 1, 2022, to March 15, 2023) due to a national shortage of epinephrine-containing lidocaine and a 6-month period using epinephrine-containing lidocaine (April 1, 2023, to October 1, 2023). A nurse navigator contacted all patients postbiopsy to assess postprocedural complications, including symptomatic hematomas. Postprocedure mammograms were reviewed for detectable hematomas after 9-gauge and 12- to 14-gauge CNBBs. Logistic regression models evaluated the associations between epinephrine-containing lidocaine use and symptomatic and mammographically evident hematomas.

Results: A total of 1157 CNBBs were performed in 967 patients; 619 received epinephrine-containing lidocaine and 538 received lidocaine alone. There were 11 (1.0%; 11/1157) symptomatic hematomas, 10 of which occurred following 9-gauge CNBBs (6 with stereotactic/tomosynthesis guidance and 4 with MRI guidance). There was no significant difference in the occurrence of symptomatic hematomas (P = .34) or mammographically evident hematomas (P = .53) after 12- to 14-gauge US-guided CNBBs performed with epinephrine-containing lidocaine vs lidocaine alone. Fewer symptomatic hematomas occurred after 9-gauge CNBBs in the epinephrine-containing lidocaine group (0.6%; 2/310) compared with the lidocaine alone (4.1%; 8/194) (P = .02). After 9-gauge CNBBs, mammographically evident hematomas were less frequent (16.1% vs 41.2%; P <.0001) with epinephrine-containing lidocaine compared with lidocaine alone.

Conclusion: Epinephrine-containing lidocaine reduced rates of symptomatic and mammographically detected hematomas after 9-gauge CNBBs. Local infiltration with epinephrine-containing lidocaine could be considered in 9-gauge CNBBs to reduce hematoma risk.

Keywords: breast biopsy; core-needle biopsy; epinephrine; hematoma; local anesthesia; postbiopsy complications.