Ms. Paulas is a 53 year old female with biopsy proven IDC of the left breast treated with neoadjuvant chemotherapy. She presents today for bracketed wire localization of the left breast for preoperative surgical guidance. On review of the prior studies, there is a biopsy marker clip and few residual calcifications identified in the left lateral breast. Per recent MRI, the biopsy marker clip is just lateral to the area of non-mass enhancement, felt to be mammographically correlated with the calcifications. This area will be bracketed with two wires for preoperative surgical guidance.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 left breast was placed in an alphanumeric grid using lateral to medial 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, two 5 cm Kopans needles were placed bracketing the biopsy marker clip/calcifications. On orthogonal mammography, adequate positioning of the needles were confirmed after adjusting depth so the needle tips were approximately 2cm deep to the center of the target. Two spring wires were then deployed. Repeat 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. Kromrey performed the procedure under direct supervision of Dr. Sheth, who was present during the procedure at all times.
Successful needle localization of the left breast biopsy marker clip/calcifications.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.