65-year-old female with known right breast malignancy and metastatic right axillary lymph node. She presents today for needle localization of the right breast malignancy (2 sites index plus adjacent satellite) and localization of right axillary lymph node which will be performed under sonographic guidance. On review of the prior studies, a right 7:00 5 cm from nipple 0.7 cm irregular hypoechoic mass corresponding to the index malignancy will be targeted. An adjacent 0.5 cm irregular hypoechoic anterior satellite mass, will also be targeted. Two abnormal right axillary lymph nodes were identified at MRI, with subsequent ultrasound-guided biopsy of one of them revealing invasive ductal carcinoma. Preprocedural ultrasound evaluation of the right axilla, revealed the clip marker to be adjacent to one of the enlarged lymph node which will be targeted.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 right breast and axilla were cleansed with chlorhexidine over the target areas. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, a 7 cm Kopans needle was placed in the index malignancy. Another 7 cm Kopans needle was placed in the adjacent satellite mass. The spring wires were then deployed. A 9 cm Kopans needle was placed in an enlarged lymph node adjacent to the biopsy clip.Repeat three view orthogonal mammograms reveal the three spring wires to be in excellent position. The posterior wire corresponds to the mass with clip. The anterior wire corresponds to the anterior satellite. The wire in the axilla corresponds to the enlarged biopsied lymph node with the clip being slightly superior to it. Patient tolerated the procedure well and was sent to the holding area in stable condition. Drs. Tremblay and Kulkarni performed the procedure. Orthogonal digital specimen radiographs were obtained and results reported separately.
1. Successful needle localization of the right breast index malignancy/adjacent satellite lesion.2. Successful needle localization of a metastatic right axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.