51-year-old with right breast high grade DCIS presents for wire localization There is a cluster of calcifications immediately anterior to the Hydromark clip placed at recent ultrasound-guided biopsy at anterior 12:00 position in the right breast. Architectural distortions are present posterior to the same marker clip. There is a rod shaped clip, which is from prior MRI guided biopsy revealing LCIS, located medial and posterior to the Hydromark clip. The plan was made to place one wire anterior to the clustered calcifications, second wire posterior to the architectural distortions, and third wire at the rod shaped 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 right breast was placed in an alphanumeric grid using superior to inferior approach. 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, a 5 cm x 1, and 9 cm x 2 Kopans needles were placed adjacent to the targets. On orthogonal mammography, 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 wires were then deployed. Repeat two view orthogonal mammograms reveal the spring wires to be in adequate 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. Abe performed the procedure.Orthogonal digital specimen radiographs revealed the calcifications and two clips and three spring wires to be within the specimen. Dr. Jaskowiak will shave posterior and inferior margins.
Successful needle localization of the right breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.