General

Synonym/Acronym:
N/A

Rationale
To assist in establishing a diagnosis of breast disease; in the presence of breast cancer, this test is also used to assist in evaluating prognosis and management of response to therapy.

Patient Preparation
There are no activity restrictions unless by medical direction. Instruct the patient that to reduce the risk of aspiration related to nausea and vomiting, solid food and milk or milk products are restricted for at least 6 hr, and clear liquids are restricted for at least 2 hr prior to general anesthesia, regional anesthesia, or sedation/analgesia (monitored anesthesia). The patient may be required to be NPO after midnight. The American Society of Anesthesiologists has fasting guidelines for risk levels according to patient status. More information can be located at www.asahq.org.

Regarding the patient’s risk for bleeding, the patient should be instructed to avoid taking natural products and medications with known anticoagulant, antiplatelet, or thrombolytic properties or to reduce dosage, as ordered, prior to the procedure. Number of days to withhold medication is dependent on the type of anticoagulant. Note the last time and dose of medication taken. Protocols may vary among facilities.

Patients on beta blockers before the surgical procedure should be instructed to take their medication as ordered during the perioperative period.

Normal Findings
(Method: Macroscopic and microscopic examination of tissue for biopsy; cytochemical or immunohistochemical for estrogen and progesterone receptors Ki67, PCNA, P53; flow cytometry for DNA ploidy and S-phase fraction; immunohistochemical or FISH for Her-2/neu) Fluorescence in situ hybridization (FISH) is a cytogenic technique that uses fluorescent-labelled DNA probes to detect specific chromosome abnormalities. Favorable findings:

• Biopsy: No abnormal cells or tissue.
• DNA ploidy: Majority diploid cell population.
• SPF: Low fraction of replicating cells in total cell population.
• Her-2/neu, Ki67, PCNA, and P53: Negative to low percentage of stained cells.
• Estrogen and progesterone receptors: High percentage of stained cells.

Critical Findings and Potential Interventions

• Assessment of clear margins after tissue excision
• Classification or grading of tumor
• Identification of malignancy

Timely notification to the requesting health-care provider (HCP) of any critical findings and related symptoms is a role expectation of the professional nurse. A listing of these findings varies among facilities.