47-year-old female with known right breast cancer presents for bracketed ultrasound-guided needle localization of index right upper outer quadrant mass and satellite lesion. On review of the prior studies, again seen is the index mass in the upper outer quadrant of the right breast at posterior depth at the 10:00 position corresponding to the patient's known history of malignancy. Additionally, note is made of a 5 x 6 mm oval mass in the upper outer quadrant of the right breast, approximately 1.4 cm inferior to the index mass, corresponding to the findings of a satellite lesion seen on prior MRI and ultrasound examination. Target well defined mass and satellite lesion are located in the right breast in the upper outer quadrant region located posteriorly at the 10 o’clock. 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 mass and satellite lesion were targeted using lateral to medial approach. The skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using ultrasound guidance, a 7 cm Kopans needle was placed adjacent to the superior margin of the right breast index mass. Using ultrasound guidance, a second 7 cm Kopans needle was placed adjacent to the inferior margin of the right breast satellite lesion. On sonography, 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. Two view orthogonal mammograms reveal the spring wires 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. Sanchez and Schacht performed the procedure. Dr. Schacht was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the mass, clip, and 2 spring wires to be within the specimen. The satellite lesion was not well seen on prior mammograms and that is true also for these images.
Successful ultrasound-guided bracketed needle localization of the right breast mass and right breast satellite lesion.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.