63 year-old female with BRCA gene mutation who presents for MRI guided biopsy of the right breast nonmass enhancement. Nonmass enhancement is identified in the medial aspect of the right breast, corresponding to the findings on the outside MRI breast, which is the target for today's MRI guided biopsy.PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor with the aid of DynaCad software. 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 6 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show a small 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 digital radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a right unilateral digital mammogram CC and ML views to locate the percutaneously placed clip. The clip is placed in the right breast at 2 o'clock position, which is approximately 1 cm lateral to the biopsy cavity. Benign calcifications are noted anterior and posterior to the biopsy cavity. No evidence of any complications due to the procedure. 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 enhancing lesion at 3 o'clock in the right breast. The biopsy clip is approximately 1 cm lateral to the biopsy cavity. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation.