49-year-old female presenting for bracketed preoperative needle localization for right breast cancer. On review of the prior studies, disease on MRI spreading almost 40 mm is visualized about 3.5 cm from the nipple. Target mixed calcifications morphology are located in the right breast in the upper inner quadrant region located in mid-breast 1 o’clock. A bracketed needle localization is performed. 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 right 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, two 7 cm Kopans needle was placed adjacent to the lesion, one anteriorly and one posteriorly. On orthogonal mammography, adequate positioning of the needles were confirmed after adjusting depth so the needle tip was approximately 2cm deep to the centers of the targets. A spring wire was then deployed through each needle. Repeat two view orthogonal mammograms reveal the spring wires to be in adequate 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. Drs. Nagaraju and Tremblay performed the procedure under direct supervision of Dr. Abe, who was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the calcifications and clip and spring wires to be within the specimen. Dr. Jaskowiak excised more superolateral tissue (not imaged).
Successful bracketed needle localization of the right breast calcifications.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.