42-year-old female with suspicious palpable right breast mass, presenting for biopsy. Patient is under the Alan Penn protocol, and had an MRI breast performed on the same day. Targeted ultrasound of the right breast at 6:00 position reveals a 2.9 x 1.9 cm irregular shadowing hypoechoic mass with indistinct margins and mild internal vascularity. This was the target for biopsy.On same day breast MRI study, an enhancing focus was identified in the medial right breast around 3:00 position. For this reason, targeted ultrasound evaluation of the medial right breast was performed which revealed a 5 x 2 x 5 mm circumscribed homogenous hypoechoic avascular mass, and benign in appearance. This mass correlates to an enhancing mass on MRI in the medial right breast.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 right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent.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 right CC and ML views revealed the percutaneously placed clip to be in the expected location in the central aspect of the lesion. No evidence of hematoma or other complication.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 Drs. Kulkarni and Tremblay. Dr. Kulkarni was present during the procedure at all times.
1. Successful ultrasound-guided core biopsy of the right breast lesion and clip placement. Pathology is pending at this time.2. Nonspecific benign-appearing subcentimeter mass within the right medial breast, 4:00, correlates to enhancing focus on same day MRI.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.