49 year-old female with history of right breast low-grade DCIS status post lumpectomy at an outside hospital. Recent MRI demonstrated an area of non mass enhancement in the right retroareolar region for which biopsy was recommended.. On subtraction images, the area of focal non mass enhancement in the right breast retroareolar region previously described on prior MRI is not as conspicuous. Using landmarks from the breast tissue, this area was chosen as the target. PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 8 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show a small hematoma at the biopsy site. An ATEC rod shaped clip was placed into the center of the target.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a right unilateral mammogram CC and ML views to locate the percutaneously placed clip. The clip is placed at 11 o'clock position with no evidence of any complications due to the procedure. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Udoji under direct supervision of Dr. Abe who was present throughout the procedure.
Successful MR guided core needle biopsy of the right breast upper outer quadrant near the 11 o'clock position non mass enhancement. Successful rod shaped clip placement. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.