Left breast invasive mammary carcinoma grade 2 with a satellite lesion located immediately inferiorly on MRI presents for bracketed needle localization. On review of the prior studies, a spiculate mass is identified in the left lower outer quadrant. Target spiculated mass morphology are located in the left breast in the lower outer quadrant region located in mid-breast 3 o’clock. A focal asymmetry immediately inferior to the mass seen on MRI is not definitely seen on the mammogram or on the specimen. The procedure, risks including bleeding, mistargeting and infection, and benefits of bracketed 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 inferior to superior 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, a posterior 9 cm Kopans needle was placed along the posterior aspect of the spiculated mass. Using coordinates from the grid, an anterior 7 cm Kopans needle was placed along the anterior aspect of the spiculated mass possibly covering the inferior focal asymmetry seen on MRI. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Repeat two view orthogonal mammograms reveal the spring wire 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. Kulkarni, who was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the mass, calcifications and spring wires to be within the specimen. The spiculations reach up to the lateral margin and therefore additional lateral margin was obtained which was not imaged.
Successful bracketed needle localization of the left breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.