28 year-old female with newly diagnosed left breast inflammatory cancer presents for MRI guided biopsy of the non mass enhancement in the right breast lower inner quadrant. On subtraction images, linear nonmass enhancement were identified in the lower inner quadrant of the posterior right breast. This was chosen as the target.PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 12 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show no significant hematoma at the biopsy site. An ATEC clip was placed into the center of the target.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent ultrasound-guided biopsy of right axillary lymph node which will be dictated in a separate report. After this MRI guided procedure and a ultrasound-guided right axillary lymph node biopsy, a right unilateral mammogram to locate the percutaneously placed clip was performed. The clip is placed at 4 o'clock position with no evidence of any complications due to the procedure. The ultrasound clip is seen in the axilla as well. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Wang under direct supervision of Dr. Schacht who was present throughout the procedure.
Successful MR guided core needle biopsy of the right breast 4 o'clock enhancing lesion. Successful clip placement. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.