Ms. Balling is a 61-year-old female with known left breast cancer status post neoadjuvant chemotherapy. She presents today for needle localization for surgical guidance. The most recent mammogram was performed in March 2013 immediately after biopsy of the left breast. Since then, patient has had multiple MRI and ultrasound examinations to reevaluate the known left breast cancer, but no recent mammograms. Thus, a full field ML and CC views were obtained prior to needle localization in order to confirm exact positioning of the localization wires. Since neoadjuvant chemotherapy administration, the tumor now has a more diffuse appearance on mammogram with biopsy marker clip located centrally within this global asymmetry. Three wires will be placed circumferentially around this global asymmetry.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, three 9 cm Kopans needle were placed circumferentially around the global asymmetry. 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. Three 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. Sheth performed the procedure.Orthogonal digital specimen radiographs revealed the global asymmetry, three wires and biopsy marker clip to be within the specimen.
Successful needle localization of the left breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.