Known left breast ADH underwent a recent MRI that showed areas of non-Mass enhancement in the left upper outer quadrant with sonographic correlate. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic area measuring 28 x 10 mm at the 1 o’clock position with increased vascularity, 1 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram 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 side/type 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, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, eight 12-gauge core needle (Suros) specimens were obtained of the lesion. Targeting was judged very good. Specimens were radiographed with digital magnification technique. 5 cores showed calcifications, segregated into 10% formalin container #1, and labeled "left breast with calcifications." The remaining core specimens were placed into formalin container #2, "left breast without calcifications." They were sent to pathology for histologic evaluation with an accompanying history sheet.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location at 1 o'clock position, 17 mm medial from the previous biopsy clip. No evidence of hematoma or other complication.Right unilateral mammogram CC and ML views were performed to locate the percutaneously placed clip from MRI guided biopsy which had been performed earlier. The clip is placed at 12 o'clock position with no evidence of any complications due to the procedure.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe.
Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.