Known left breast IDC post neoadjuvant chemotherapy presents for triple wire needle localization On review of the prior studies, significant reduction in size of the known mass in the left upper-outer quadrant is noted. A clip is identified along the posterior aspect of the mass. A vague band like focal asymmetry is located anterior and posterior to the clip. Recent MRI dated 9/22/2015 demonstrated area of non mass enhancement anterior and posterior to the clip spanning approximately 5.9 x 3.7 x 2.5 cm. Plan is to perform a triple wire needle localization targeting the posteriormost extent of focal asymmetry, the clip in the midportion and the anteriormost extent of the focal asymmetry. The procedure, risks including bleeding, mistargeting and infection, and benefits of triple 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, a 9 cm Kopans needle was placed posterior most extent of the focal asymmetry, 7 cm Kopans needle was placed at the clip in the midportion, and a 9 cm Kopans needle was placed at the anterior most extent of the focal asymmetry. On orthogonal mammography, adequate positioning of the needles was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the targets. The spring wires were 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. Kulkarni performed the procedure and was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the 3 wires, one clip, focal asymmetry to be within the specimen.
Successful needle localization of the left breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.