Ms. Warshaw is a 27 year-old female with history of BRCA mutation, found to have a new area of mammographically occult linear nonmass enhancement in the left lateral breast at the 3:00 position. Patient presenting for MRI guided biopsy.. On subtraction images, there is a subtle 2 cm area of non masslike enhancement in the left lateral breast which becomes more conspicuous on the delayed postcontrast image. This finding corresponds to previously reported finding on MRI study of 7/21/2016. This was chosen as a target.PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor with the aid of DynaCad software. 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 6 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 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 digital radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a left unilateral digital mammogram CC and ML views to locate the percutaneously placed clip. The clip is appropriately located with respect to the biopsied target, and is located in the left upper outer breast 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. Tremblay under direct supervision of Dr. Sheth who was present throughout the procedure.
Successful MR guided core needle biopsy of the enhancing lesion at 3 o'clock in the left breast. Successful clip placement. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.