55 year-old female. Two masses in the right breast, 3:00 and 9:00 position that are highly suspicious for malignancy. Participating in Allen Penn, MRI research study. Right ultrasound re-identified the target lesions for biopsy. The two lesions to be targeted are a hypoechoic 2 x 1.8 x 2.4 cm mass at the 3 o’clock position 1 cm from the nipple and a 2.1 x 1.1 mass at the 9 o'clock position 4 cm from the nipple. The lesions were readily visible. Targeted ultrasound was also done of the 12 o'clock position 1 cm from the nipple in the area of the irregular enhancing mass seen on same day MRI. This corresponded to a 0.9 x 0.5 x 0.9 cm hypoechoic mass, suspicious for a malignancy.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. The 3 o'clock position lesion was first targeted. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 12-gauge core needle (Celero) specimens were obtained of the 3 o'clock position lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent.Following this, a second skin entry was made for the 9 o'clock position lesion. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 12-gauge core needle (Celero) specimens were obtained of the 9 o'clock position 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 two Hydromark clips were placed into the two lesions 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 two percutaneously placed clips to be in the expected location within the two lesions. 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 Dr. Xiong and Dr. Abe, who was present during the procedure at all times.
Successful ultrasound-guided core biopsy of the two right breast lesions and clip placement. This is most likely a malignancy. Pathology is pending at this time.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.