59 year-old with biopsy-proven invasive carcinoma in the left upper outer breast. Additionally a stereotactic biopsy of the left breast at a central site showed ADH. On review of the prior studies, MRI 11/4/2015 and prior mammograms the small mass and area of previous calcifications/displaced clip are noted. Target ill defined mass is located in the left breast in the upper outer quadrant region located posteriorly at 2 o’clock. Also, target area of previous calcifications are located in the left breast in the central region located 5 cm lateral to the 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 for both lesions. 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 9 cm Kopans needle was placed at both targets, one at a time. On orthogonal mammography, adequate positioning of the needles were confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. Spring wires were sequentially deployed. Repeat two view orthogonal mammograms reveal the spring wires to be in good 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. It was understood that the biopsy clip is 5 cm medial to the site of previous calcifications for the more anterior inferior wire. Dr. Schacht performed the procedure.Two sets of orthogonal digital specimen radiographs revealed the mass and spring wire to be within one specimen (IDC) and a spring wire to be in the 2nd specimen (ADH). The mass was relatively close to one margin on the IDC specimen and a small additional tissue sample was obtained.
Successful needle localization of the left breast mass and site of prior 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.