2. INTERVENTIONAL

3. LOCALIZATIONS Needle Localizations Parallel Approach/Surgical Approach AP Approach/Surgical Approach How Lesions Move Set-up/Procedure

4. 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

5. 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

6. 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

7. 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

8. CC: Watch #9

9. MLO: Note 9 and 12

10. ML: Note 9 and 3

11. Watch number 3

12. MLO

13. ML

19. Set-up/Procedure Black marker Betadine swabs Sterile gloves Lidocaine Needle/wire Methylene blue dye/air/Tape

20. NEEDLES

21. PADDLES

22. PARALLEL APPROACH

23. LOCALIZATION CC

24. PREP THE SKIN

25. LOCATE WITH GRID

26. INSERT NEEDLE IN CC

27. INSERT NEEDLE

28. ADJUST NEEDLE DEPTH IN LATERAL VIEW

29. CC WITH NEEDLE INSERTED

30. LATERAL WITH NEEDLE

31. NEEDLE REMOVED/WIRE LEFT

32. LAT VIEW WITH NEEDLE

33. LAT VIEW OF WIRE

34. From X-ray

35. Surgeon will intersect palpable needle

36. Incision

37. Tissue localized by feeling needle

38. Stabilizer unscrewed and discarded

39. Tissue delivered with J wire

40. Tissue and wire

41. Mammographic Image

42. 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?

43. Specimen Imaging Must follow up biopsy with Mammographic image All facilities image specimen then send both to pathology Many devices used

44. Infiltrating DC Fibroadenoma

45. SPECIMEN

46. PATHOLOGY

49. BIOPSY PROCEDURES Fine Needle Aspiration Needle Core Biopsy Ultrasound Guided Biopsy Excisional Biopsy Incisional Biopsy Stereotactic Biopsy

50. Surgical Procedures Extended Radical Mastectomies Total or Simple Mastectomies Quadrantectomies Partial Mastectomy Lumpectomies Sentinel Node

51. MAMMOGRAPHIC CHANGES DUE TO SURGERY Tissue Distortion Mass: Hematoma, Seroma, abscess Fat Necrosis Calcium Edema Skin Thickening

52. Malignancy on left side palpable but one on right was not.

53. Mammo 2 years post surgery

54. HEMATOMA AFTER LUMPECTOMY

55. Eight months later the hematoma is resolving.

56. 1 ½ Years later hematoma smaller Lipid cyst developed at site

57. Calcified Suture Material in Postirradiated Breast

58. CALCIFIED DUCTAL SYSTEM AFTER IRRADIATION

59. 8 MONTHS AFTER EXCISION AND IRRADIATION CALC DEVEL.

60. POST-BIOPSY SCAR

61. ADJUVANT THERAPY Radiotherapy Chemotherapy Brachytherapy Hormonal Therapy Tamoxifen

62. SPECIAL PROCEDURES Galactography/Ductography (pg 324) Pneumocystography (pg 324) Ultrasound MRI CAD Nuclear Medicine

63. DUCTOGRAM

65. ADDITIONAL METHODS Digital Mammography Optical: Transillumination Laser CT (CTML) Infrared Imaging Spectroscopy Automated Doppler Ultrasound Genetics Screening Ductal Lavage

66. COSMETIC SURGERY pg 294-309 Augmentation Mammoplasty Paraffin Silicone Fat Saline Reduction Mammoplasty