Needle-Localized Breast Biopsy

Abstract

Indications • Abnormal mammogram (nonpalpable lesion) not amenable to image-directed core biopsy • Also used (as a lumpectomy) for excision of core biopsy-proven malignant and lesions of uncertain malignant potential-Invasive breast cancer or ductal carcinoma in situ-Lesions that have a significant risk of upgrading to a malignant diagnosis such as ADH (atypical ductal hyperplasia)-Possible discordant core biopsy Essential Steps 1. Confirm side of surgery. 2. Preoperative localizing wire placed under mammographic or ultrasound guidance. 3. Check localizing studies and estimate trajec-tory of wire and location of mass. 4. Local/general anesthesia. 5. Circumareolar incision/incision over mass/incision midway between mass and needle entry site into the skin. 6. Develop flaps. 7. Deliver wire into the operative field. 8. Place traction stitch. 9. Carefully remove the mass of the tissue around the wire and the tip of the wire. 10. If methylene blue was injected by mammog-raphy, keep the dissection plane away from blue-stained tissues. 11. Orient the specimen. 12. Send to radiology for confirmation. 13. Attain hemostasis. 14. After receiving confirmation, close the wound. Note These Variations • Location of incision, type of wire • Use of methylene blue Complications • Missed lesion • Incomplete excision • Wire broken/transected during dissection, unable to retrieve • Hematoma