What is the role of radiography in breast biopsy with needle localization?

Updated: Dec 28, 2015
  • Author: William Teh, MBChB, FRCR; more...
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Answer

Techniques that involve mammography usually require the upright mammographic attachment on a normal mammographic unit, although localizations with stereotactic prone tables also have been described. Before stereotaxy came into use, a grid (see the image below) or holey plate was used to calculate the position of needle placement in the X and Y planes.

Grid technique of localization. Grid technique of localization.

The depth was calculated from the lateromedial projection. The position was then checked according to the superimposition of target, hub, and shaft of the needle, and the required depth was verified on the orthogonal view (see the following image).

Orthogonal (mediolateral) projection confirms the Orthogonal (mediolateral) projection confirms the position of the needle to be placed beyond the cluster of microcalcification.

Stereotaxy enables the exact position to be located. The needle is then placed 1 cm beyond the lesion to ensure that it is adequately transfixed. Because of the accordion effect (the thickness of the breast expands when compression is released), the needle tip may migrate, causing the needle to be placed short of the lesion. [14] The final depth of the needle is therefore checked on the orthogonal view to ensure that the lesion is adequately transfixed.

Different needles exist, and most are introduced by using a stiffer, coaxial needle. Some needles are then removed, leaving the wire in situ. The wires commonly have a barb or hook that is deployed in the final position to anchor the wire in place. Some needles require the outer cannula to be retained in situ (see the image below). The choice of needles and wires used are dictated by the preference of the radiologist and the surgeons.

Image shows the specimen radiograph with a stellat Image shows the specimen radiograph with a stellate lesion containing clustered, pleomorphic microcalcification with wire in situ. Note the use of a stiff outer cannula.

After surgical removal of the lesion, specimen radiography must be performed to ensure that the lesion was adequately excised (see the following image).

Specimen radiograph shows the wire and the localiz Specimen radiograph shows the wire and the localized speculated mass in situ, with a good excision margin.

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