Patient is a 60-year-old female with recent biopsy proven left breast cancer who presents for ultrasound-guided biopsy of the additional lesion in the left breast. Upon review the mammogram from outside facility, there is a satellite lesion posterior to the index mass on the mammogram without a sonographic correlate. Repeat ultrasound of the left breast reidentified the index lesion with the clip at 12:00, 1 cm from the nipple. Subsequently, 1 cm lateral and inferomedial to the index mass, in the left breast, 1:00 location, 1 cm from the nipple, there is a 10 x 9 x 5 mm slightly hypoechoic irregular mass with increased flow, which likely corresponds to the posterior satellite lesion on the mammogram. In addition, in the left breast, 2:00 location, 1 cm from the nipple, there is a 6 mm lesion 6 mm inferior and lateral to the index mass and likely corresponding to the findings on the MRI 10/26/2015. These findings were reviewed with Dr. Jaskowiak in the reading room. The 2:00 satellite lesion would be targeted for biopsy and clip placed along the lateral/posterior aspect of the 2:00 mass, towards the 1:00 finding. PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, three 14-gauge core needle (Achieve) specimens were obtained of the lesion. Targeting was judged very good. Two specimens sank to the bottom of the prefilled container of 10% formalin. One specimen floated. The floating specimen was the initial core, towards the 1:00 lesion obtained with open trough technique. Subsequently, firing technique was needed to get through the patient's dense tissue and more accurately target the 2:00 finding. Both subsequent cores sank. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed near the 2:00 lesion, towards the 1:00 lesion. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Schacht. Dr. Schacht was present during the procedure at all times.
Successful ultrasound-guided core biopsy of the left breast satellite lesion and clip placement. Pathology is pending at this time.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.