INTERVENTIONAL

LOCALIZATIONS

Needle LocalizationsParallel 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 approachNeedle/wire inserted close to areolaMuch more cosmeticOften used in Ultrasound

DISADVANTAGENot optimal for lesions located near chest wallMore 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 smallerLipid 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

DUCTOGRAM

ADDITIONAL METHODS

Digital Mammography

Optical: Transillumination

Laser CT (CTML)

Infrared Imaging Spectroscopy

Automated Doppler Ultrasound

Genetics Screening

Ductal Lavage

COSMETIC SURGERY pg 294-309

Augmentation MammoplastyParaffin

Silicone

Fat

Saline

Reduction Mammoplasty