Breast Ultrasound for the Interventionalist

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Presentation transcript:

Breast Ultrasound for the Interventionalist Madhavi Raghu, MD, Regina Hooley, MD Techniques in Vascular & Interventional Radiology Volume 17, Issue 1, Pages 16-22 (March 2014) DOI: 10.1053/j.tvir.2013.12.004 Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 1 Before any US procedure, the breast should be cleansed and draped appropriately (A). A sterile probe cover can be used, and local anesthetic is infused along the short axis of the probe (B, arrow). The fourth and fifth digits and the heel of the hand are used to anchor the breast and the probe. The biopsy device is inserted into the breast along the short axis and parallel to the probe, directly beneath the US beam for optimal needle visualization (C, arrows). (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 16-22DOI: (10.1053/j.tvir.2013.12.004) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 2 FNA of a simple cyst with an 18-gauge needle, for symptomatic relief in a 59-year-old woman. Preprocedure image is obtained to confirm the appropriate target (A). Preaspiration image demonstrates the needle tip (arrow) in the cyst (B) and near complete resolution of the abnormality following aspiration (C). Techniques in Vascular & Interventional Radiology 2014 17, 16-22DOI: (10.1053/j.tvir.2013.12.004) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 3 Ultrasound-guided CNB with a 14-gauge automated device (A) of a highly suspicious irregular mass with calcifications (dashed arrow) in a 62-year-old woman. Pathology showed infiltrative ductal carcinoma. Prefire image demonstrates the tip of the device (arrow) just proximal to the mass. Postfire image (B) shows the needle in a parallel orientation and the tip (arrow) clearly visualized. Before clip deployment, the tip of the needle should be within the center of the mass (C, arrow). Once the clip is deployed, an image (D) of the mass with the clip (arrow) should be documented. Techniques in Vascular & Interventional Radiology 2014 17, 16-22DOI: (10.1053/j.tvir.2013.12.004) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 4 Ultrasound-guided 14-gauge CNB of an abnormal axillary lymph node in a 73-year-old woman with a history of uterine cancer. Pathology showed metastatic adenocarcinoma. Prebiopsy color Doppler (A) image demonstrates an absence of surrounding vascular structures. Prefire (B) image demonstrates a portion of the lymph node, cortex, and adjacent breast tissue (arrows) within the trough (dashed arrows) of the device. The tip (short arrow) of the device should always be visualized. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 16-22DOI: (10.1053/j.tvir.2013.12.004) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 5 A 49-year-old asymptomatic woman was recalled from screening for a solitary dilated duct in the left retroareolar region (A). Targeted ultrasound demonstrated a lobulated intraductal mass (B, arrow) with internal vascularity (C). VAB was performed with the mass (arrow) in the open trough (D, short arrows). Pathology showed papilloma, confirmed with excision. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 16-22DOI: (10.1053/j.tvir.2013.12.004) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 6 Preoperative wire localization of an intraductal papilloma in a 64-year-old woman (A). A 5-cm needle was inserted along the short axis of the probe and the tip (arrow) of the needle located 1cm beyond the lesion (B). Once the wire was deployed (C), the thick portion of the wire (short arrows) is within the mass (dashed arrow) and the tip of the hook (white arrow) clearly visualized. Cursors (+) measure the hook is 1.3cm beyond the edge of the lesion. Orthogonal view obtained with the wire along the long axis of the probe demonstrates the wire within the mass (D, arrow). Techniques in Vascular & Interventional Radiology 2014 17, 16-22DOI: (10.1053/j.tvir.2013.12.004) Copyright © 2014 Elsevier Inc. Terms and Conditions