Alignment Bars on Breast
Introducing the Needle into the Breast
Needle is imaged from another direction
Needle introduced
Passing the placement wire through the needle
Patient goes to operating room - Surgeon follows the wire to abnormality in breast

Alignment Bars on Breast

IN approximately 1-2% of women an abnormality will be seen on a mammogram that raises some concern. Fortunately more than 70% of these turn out to be nothing serious. Approximately 20-25%, however, are breast cancers. The fact that they are visible by mammography and not evident on a clinical breast examination usually means that the cancers are small, and highly treatable.

Since most are not breast cancer, further tests are needed to separate findings on a mammogram that are breast cancer from those that are not. Sometimes ultrasound can help, but often a tissue diagnosis is needed. The most accurate method for determining what something is is to have it surgically removed so that a pathologist can evaluate it under the microscope. Since the surgeon cannot feel these lesions the radiologist guides the surgeon by placing a guidewire at the abnormality using mammography, ultrasound, magnetic resonance, or computed tomography to monitor the positioning.

In this picture the radiologist has chosen the lateral side of the left breast for introducing a needle that is used to position the wire guide. An x-ray shows the radiologist where the lesion is in the window in the compression paddle, and alignment bars are placed using the coordinates alongside the window.

Introducing the Needle into the Breast

The skin has been cleansed for sterility and local anesthesia has been introduced using a small needle to numb the area. The radiologist is now positioning the introducing needle into the breast in the direction of the abnormality based on the mammogram

Needle is imaged from another direction

Once the needle is in position the patient is backed out of the x-ray machine and the system is rotated so that the needle can be imaged from the other direction (90 degrees to the first position) to adjust the depth.

Needle introduced

Passing the placement wire through the needle

The radiologist passes the wire through the introducing needle so that the wire anchors at the suspicious lesion

Patient goes to operating room - Surgeon follows the wire to abnormality in breast

The wire is now at the lesion and the patient can go to the outpatient operating room where the surgeon, using local anesthesia, and by following the wire, can go down to the abnormality and remove it.