What labs are best for evaluating lumpectomy complications?

Laboratory Evaluation for Lumpectomy Complications

For evaluating lumpectomy complications, obtain a complete blood count (CBC) and liver function tests (LFTs) as the primary laboratory studies, with additional testing guided by specific clinical signs and symptoms. 1

Core Laboratory Panel

CBC with Differential

• Essential for detecting infection, anemia from bleeding, and hematologic abnormalities that may complicate recovery 2, 3
• Hemoglobin and hematocrit assess for postoperative bleeding or anemia requiring intervention 2
• White blood cell count with differential identifies infectious complications such as wound infection or abscess 3
• Platelet count evaluates clotting function, particularly important if bleeding complications are suspected 2

Liver Function Tests

• Recommended when systemic therapy is being considered or if clinically indicated 1
• Alkaline phosphatase elevation may prompt additional imaging if metastatic disease is suspected 1
• Abnormal LFTs warrant abdominal imaging with CT or MRI to evaluate for distant disease 1

Symptom-Directed Additional Testing

For Suspected Infection

• C-reactive protein (CRP) to assess inflammatory processes if wound infection or abscess is suspected 3
• Blood cultures if systemic infection or sepsis is a concern 3

For Bleeding Complications

• Comprehensive metabolic panel including electrolytes and renal function if significant blood loss or fluid shifts have occurred 3
• Coagulation studies (PT/INR, PTT) if coagulopathy is suspected or patient is anticoagulated 3

For Metabolic Concerns

• Blood gas analysis with base excess and lactate levels if tissue perfusion is compromised or severe systemic complications are present 3

Important Clinical Caveats

Avoid Routine Extensive Testing

• The NCCN guidelines explicitly state that routine systemic imaging is not indicated for early-stage breast cancer patients in the absence of signs/symptoms of metastatic disease 1
• Additional tests should only be ordered based on specific clinical signs and symptoms, not as routine screening 1

Common Pitfalls to Avoid

• Do not order bone scans, chest CT, or abdominal imaging unless specific symptoms are present (localized bone pain, pulmonary symptoms, abdominal symptoms, or elevated alkaline phosphatase) 1
• Laboratory abnormalities in simple postoperative cases typically resolve with hydration and supportive care 3
• Persistent laboratory abnormalities despite clinical improvement should prompt investigation for alternative etiologies 3

Timing Considerations

Most unplanned reoperations for lumpectomy complications occur at a mean of 13.4 days postoperatively, with bleeding being the most common complication requiring reoperation 4. Laboratory evaluation should be timed appropriately when complications are suspected during this high-risk period.