Ms. Bourke is a 57 year old female with biopsy-proven DCIS. She presents today for MR guided wire localization for the left breast prior to surgery, since the MRI findings were more extensive than the mammographic findings. On subtraction images, the area of clumped non-mass enhancement in the left lateral breast is again identified. The anterior and posterior extent of this enhancement is identified as targets for the bracketed wire localization. PROCEDURE:Coordinates of the anterior and posterior extent of non-mass enhancement were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. An MR-compatible needle with wire was placed at the anterior extent and posterior extent. Adequate positioning of the needles were confirmed after adjusting depth so the needle tips were approximately 2cm deep to the center of the targets. Subsequent MR images confirmed satisfactory positioning of the needles. Spring wires were then deployed.Two view orthogonal mammograms reveal the two spring wires to be in the expected position, when compared to the imaging from the recent MRI examination. Of note, the biopsy clip is located medial to the area of clumped non-mass enhancement identified on MRI. 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. Sheth performed the procedure under direct supervision of Dr. Kulkarni, who was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the two wires, calcifications to be within the specimen. A marking clip was noted separately along the periphery of the specimen. Few calcifications noted along the medial margin. Per conversation with Dr. Jaskowiak, additional tissue from the superior and medial margins will be removed but no radiographed.
Successful MR-guided bracketed wire localization of the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.