INTERVENTIONAL
LOCALIZATIONS Needle Localizations Parallel Approach/Surgical Approach AP Approach/Surgical Approach How Lesions Move Set-up/Procedure
PARALLEL APPROACH Approach parallels chest wall Used for lesions not palpable ADVANTAGE No chance of rupturing chest wall DISADVANTAGES Not always ideal for surgeon Compression
PARALLEL APPROACH Always compress with lesion closest to compression device Lesions located superior: CC Lesions located medial or LIQ: ML Lesions located lateral or LOQ: LM
AP APPROACH Parallels surgical approach Needle/wire inserted close to areola Much more cosmetic Often used in Ultrasound DISADVANTAGE Not optimal for lesions located near chest wall More difficult for Physician to perform
HOW LESIONS MOVE Medial lesions move up on a lateral view from an oblique view Lateral lesions move down on lateral view from an oblique view
CC: Watch #9
MLO: Note 9 and 12
ML: Note 9 and 3
Watch number 3
MLO
ML
Set-up/Procedure Black marker Betadine swabs Sterile gloves Lidocaine Needle/wire Methylene blue dye/air/Tape
NEEDLES
PADDLES
PARALLEL APPROACH
LOCALIZATION CC
PREP THE SKIN
LOCATE WITH GRID
INSERT NEEDLE IN CC
INSERT NEEDLE
ADJUST NEEDLE DEPTH IN LATERAL VIEW
CC WITH NEEDLE INSERTED
LATERAL WITH NEEDLE
NEEDLE REMOVED/WIRE LEFT
LAT VIEW WITH NEEDLE
LAT VIEW OF WIRE
From X-ray
Surgeon will intersect palpable needle
Incision
Tissue localized by feeling needle
Stabilizer unscrewed and discarded
Tissue delivered with J wire
Tissue and wire
Mammographic Image
If a lesion is located in the lateral aspect of the breast, which way will it move when going from an MLO to a 90 degree LAT? If a lesion is located at 5:00 in the right breast, what position do you set the patient/tube up for a needle localization?
Specimen Imaging Must follow up biopsy with Mammographic image All facilities image specimen then send both to pathology Many devices used
Infiltrating DC Fibroadenoma
SPECIMEN
PATHOLOGY
BIOPSY PROCEDURES Fine Needle Aspiration Needle Core Biopsy Ultrasound Guided Biopsy Excisional Biopsy Incisional Biopsy Stereotactic Biopsy
Surgical Procedures Extended Radical Mastectomies Total or Simple Mastectomies Quadrantectomies Partial Mastectomy Lumpectomies Sentinel Node
MAMMOGRAPHIC CHANGES DUE TO SURGERY Tissue Distortion Mass: Hematoma, Seroma, abscess Fat Necrosis Calcium Edema Skin Thickening
Malignancy on left side palpable but one on right was not.
Mammo 2 years post surgery
HEMATOMA AFTER LUMPECTOMY
Eight months later the hematoma is resolving.
1 ½ Years later hematoma smaller Lipid cyst developed at site
Calcified Suture Material in Postirradiated Breast
CALCIFIED DUCTAL SYSTEM AFTER IRRADIATION
8 MONTHS AFTER EXCISION AND IRRADIATION CALC DEVEL.
POST-BIOPSY SCAR
ADJUVANT THERAPY Radiotherapy Chemotherapy Brachytherapy Hormonal Therapy Tamoxifen
SPECIAL PROCEDURES Galactography/Ductography (pg 324) Pneumocystography (pg 324) Ultrasound MRI CAD Nuclear Medicine
DUCTOGRAM
ADDITIONAL METHODS Digital Mammography Optical: Transillumination Laser CT (CTML) Infrared Imaging Spectroscopy Automated Doppler Ultrasound Genetics Screening Ductal Lavage
COSMETIC SURGERY pg Augmentation Mammoplasty Paraffin Silicone Fat Saline Reduction Mammoplasty