INTERVENTIONAL LOCALIZATIONS Needle Localizations Parallel Approach/Surgical Approach AP...

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INTERVENTIONAL

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LOCALIZATIONS

Needle LocalizationsParallel Approach/Surgical Approach

AP Approach/Surgical Approach

How Lesions Move

Set-up/Procedure

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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

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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

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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

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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

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CC: Watch #9

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MLO: Note 9 and 12

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ML: Note 9 and 3

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Watch number 3

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MLO

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ML

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Set-up/Procedure

Black marker

Betadine swabs

Sterile gloves

Lidocaine

Needle/wire

Methylene blue dye/air/Tape

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NEEDLES

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PADDLES

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PARALLEL APPROACH

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LOCALIZATION CC

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PREP THE SKIN

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LOCATE WITH GRID

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INSERT NEEDLE IN CC

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INSERT NEEDLE

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ADJUST NEEDLE DEPTH IN LATERAL VIEW

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CC WITH NEEDLE INSERTED

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LATERAL WITH NEEDLE

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NEEDLE REMOVED/WIRE LEFT

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LAT VIEW WITH NEEDLE

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LAT VIEW OF WIRE

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From X-ray

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Surgeon will intersect palpable needle

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Incision

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Tissue localized by feeling needle

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Stabilizer unscrewed and discarded

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Tissue delivered with J wire

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Tissue and wire

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Mammographic Image

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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?

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Specimen Imaging

Must follow up biopsy with Mammographic image

All facilities image specimen then send both to pathology

Many devices used

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Infiltrating DC Fibroadenoma

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SPECIMEN

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PATHOLOGY

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BIOPSY PROCEDURES

Fine Needle Aspiration

Needle Core Biopsy

Ultrasound Guided Biopsy

Excisional Biopsy

Incisional Biopsy

Stereotactic Biopsy

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Surgical Procedures

Extended Radical Mastectomies

Total or Simple Mastectomies

Quadrantectomies

Partial Mastectomy

Lumpectomies

Sentinel Node

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MAMMOGRAPHIC CHANGES DUE TO SURGERY

Tissue Distortion

Mass: Hematoma, Seroma, abscess

Fat Necrosis

Calcium

Edema

Skin Thickening

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

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Mammo 2 years post surgery

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HEMATOMA AFTER LUMPECTOMY

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Eight months later the hematoma is resolving.

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1 ½ Years later hematoma smallerLipid cyst developed at site

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Calcified Suture Material in Postirradiated Breast

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CALCIFIED DUCTAL SYSTEM AFTER IRRADIATION

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8 MONTHS AFTER EXCISION AND IRRADIATION CALC DEVEL.

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POST-BIOPSY SCAR

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ADJUVANT THERAPY

Radiotherapy

Chemotherapy

Brachytherapy

Hormonal Therapy

Tamoxifen

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SPECIAL PROCEDURES

Galactography/Ductography (pg 324)

Pneumocystography (pg 324)

Ultrasound

MRI

CAD

Nuclear Medicine

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DUCTOGRAM

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DUCTOGRAM

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ADDITIONAL METHODS

Digital Mammography

Optical: Transillumination

Laser CT (CTML)

Infrared Imaging Spectroscopy

Automated Doppler Ultrasound

Genetics Screening

Ductal Lavage

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COSMETIC SURGERY pg 294-309

Augmentation MammoplastyParaffin

Silicone

Fat

Saline

Reduction Mammoplasty


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