Transcript INTERVENTIONAL

INTERVENTIONAL
LOCALIZATIONS
Needle Localizations
Parallel 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 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
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 smaller
Lipid 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 Mammoplasty
Paraffin
Silicone
Fat
Saline
Reduction Mammoplasty