1. Ultrasound-Guided Percutaneous Breast Biopsy
Mary S. Newell, MD, Mary C. Mahoney, MD, FACR 
Techniques in Vascular & Interventional Radiology 
Volume 17, Issue 1, Pages (March 2014)
DOI: /j.tvir
Copyright © 2014 Elsevier Inc. Terms and Conditions

2. Figure 1
For lesions in the lateral, superior, or inferior breast, the patient is optimally positioned in the supine oblique position, with arm extended above the head.
Techniques in Vascular & Interventional Radiology  , 23-31DOI: ( /j.tvir )
Copyright © 2014 Elsevier Inc. Terms and Conditions

3. Figure 2
For a woman with small breasts, or in male patients, arm may be placed at side, to allow bolstering of breast tissue, increasing breast thickness. This works especially well with medial breast lesions.
Techniques in Vascular & Interventional Radiology  , 23-31DOI: ( /j.tvir )
Copyright © 2014 Elsevier Inc. Terms and Conditions

4. Figure 3
The biopsy may proceed with the physician holding both the transducer and the needle (A) or with the technologist scanning as the physician manipulates the needle (B), dependent on personal preference.
Techniques in Vascular & Interventional Radiology  , 23-31DOI: ( /j.tvir )
Copyright © 2014 Elsevier Inc. Terms and Conditions

5. Figure 4
For superficial lesions or those with a large buffer of tissue between lesion and chest wall, needle entry site can lie close to transducer and a relatively vertical needle path pursued (A). However, for more posterior lesions, the expected needle trajectory must be considered while planning entry site and needle angulation, to avoid inadvertent puncture of chest wall (B). If unsafe trajectory is suspected, skin puncture site should be migrated away from the transducer to allow a parallel approach (C).
Techniques in Vascular & Interventional Radiology  , 23-31DOI: ( /j.tvir )
Copyright © 2014 Elsevier Inc. Terms and Conditions

6. Figure 5
Although there are advantages to using a coaxial system during biopsy, 1 disadvantage is the introduction of air along the needle path (arrows) as the needle is removed and replaced between passes, which can obscure portions of the introducer.
Techniques in Vascular & Interventional Radiology  , 23-31DOI: ( /j.tvir )
Copyright © 2014 Elsevier Inc. Terms and Conditions

7. Figure 6
Spring-loaded needle. (A) In the prefire position, needle tip (arrowhead) should be placed at the margin of most lesions (arrow), with needle parallel or near parallel to chest wall. (B) Postfire images should be documented and should definitively outline the needle traversing the lesion (arrow). The tip of the needle may lie beyond the lesion margin in some cases, depending on the size of the target (arrowhead).
Techniques in Vascular & Interventional Radiology  , 23-31DOI: ( /j.tvir )
Copyright © 2014 Elsevier Inc. Terms and Conditions

8. Figure 7
Hyperechoic lines (arrows) seen in mass after needle has been removed represent air tracts and confirm that the lesion was successfully traversed.
Techniques in Vascular & Interventional Radiology  , 23-31DOI: ( /j.tvir )
Copyright © 2014 Elsevier Inc. Terms and Conditions

9. Figure 8
Reorientation of the needle angulation after placement in breast allows a safe, parallel approach while minimizing the distance that the needle must traverse.
Techniques in Vascular & Interventional Radiology  , 23-31DOI: ( /j.tvir )
Copyright © 2014 Elsevier Inc. Terms and Conditions

10. Figure 9
Steep needle entry may hinder needle visibility, owing to angle of the incident beam (A). However, either transducer face or needle orientation can be altered in real time to correct for this phenomenon (B).
Techniques in Vascular & Interventional Radiology  , 23-31DOI: ( /j.tvir )
Copyright © 2014 Elsevier Inc. Terms and Conditions

11. Figure 10
For small lesions, placing the tip of device too close to lesion margin may result in the sampling notch being “thrown” beyond the lesion on firing, potentially resulting in undersampling (A). In these cases, the needle may be retracted slightly from lesion, such that on firing, the lesion can be expected to lie centrally in the device notch (B).
Techniques in Vascular & Interventional Radiology  , 23-31DOI: ( /j.tvir )
Copyright © 2014 Elsevier Inc. Terms and Conditions