52-year-old female with left breast multicentric breast cancer, presents for needle localization. On review of the prior studies, breast MRI dated 7/20/2016 and mammogram dated 6/21/2016. Target spiculated mass morphology is located in the left breast in the superior region located anterior 12 o’clock, with adjacent 'lock-shaped' clip. Another target focal asymmetry with few pleomorphic calcifications at the left upper inner quadrant is located at the 2:00 position, also with adjacent biopsy clip.The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization 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 site of procedure. The left breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 7 cm Kopans needle was placed through the lesion. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Wire placement was performed for the two sites, anterior 12:00 lesion and posterior 2:00 lesion. Repeat two view orthogonal mammograms reveal the spring wire to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Tremblay performed the procedure under direct supervision of Dr. Abe, who was present during the procedure at all times.Orthogonal digital specimen radiographs obtained from the more anterior target reveals the spiculated mass, lock shaped biopsy marker and spring wire to be within the specimen. Of note, spiculations extend to the anterior and superior margins of the specimen. Findings discussed with Dr. Jaskowiak , and additional tissue was resected along the margins (no image).Orthogonal digital specimen radiographs obtained from the more posterior target, reveals the clip and spring wire to be within the specimen. Additional tissue from lateral margin was excised (no image).
Successful double needle localization of the left breast anterior upper mass and upper outer focal asymmetry.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.