54-year-old woman with left breast cancer (biopsy proven invasive ductal carcinoma) presents for wire localization for surgery. Of note, an area anterior to the biopsy-proven cancer was biopsied via MRI guidance with benign concordant pathology results. On review of the prior studies, there is a biopsy-proven invasive ductal carcinoma in the left breast outer lower quadrant posterior depth. Of note, an additional suspicious area anterior to the biopsy-proven cancer was biopsied via MRI guidance with benign pathology. There was suboptimal visualization of the target on the mammographic views. Therefore, the procedure was converted to an ultrasound-guided localization.Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 22 x 16 x 19 mm at the 4 o’clock position with increased vascularity, 5 cm from the nipple. The lesion was readily visible. The procedure, risks including bleeding, mis-targeting 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 cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, a 7 cm Kopans needle was placed through the lesion approximately 2cm deep to the center of the target. A spring wire was then deployed. Two view orthogonal mammograms reveal the spring wire 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. The procedure was performed by Dr. Udoji. Dr. Abe was present during the procedure at all times. Orthogonal digital specimen radiographs revealed the mass and clip and spring wire to be within the specimen and discussed with Dr. Jaskowiak.
Successful ultrasound guided needle localization of the left breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.