DATE OF PROCEDURE: MM/DD/YYYY
PREPROCEDURE DIAGNOSIS: Microcalcifications, right breast, x2.
POSTPROCEDURE DIAGNOSIS: Microcalcifications, right breast, x2.
PROCEDURE PERFORMED: Stereotactic Mammotome biopsy, right breast, with clip localization x2.
SURGEON: John Doe, MD
ANESTHESIA: Local.
DESCRIPTION OF PROCEDURE: The patient was brought to the stereotactic room and placed prone on the table with the right breast compressed in the lateral to medial fashion. The clusters of calcifications in the upper outer quadrant were identified on scout images. Stereotactic views were obtained. The lesion was targeted. Mammographic coordinates were calculated. The breast was prepped with ChloraPrep and anesthetized with 1% lidocaine. A 3 mm puncture incision was made through the skin and an 11 gauge Mammotome probe was inserted and directed to the calcifications using the mammographic coordinates. Prefire images were obtained revealing good position of the probe. Corrections made on the X-axis and the device was fired. Postfire images revealed accurate position of the probe. Following that, the mechanical cutter was activated. Tissue was cut, excised and transported through the probe. Multiple samples of tissue were obtained, rotating the thumbwheel two full turns through the hands of the clock. Samples were sent for specimen radiography, which revealed multiple samples of calcifications within the specimens. Specimens were then sent to pathology for routine examination labeled site A. The probe was backed out of the breast 5 mm and the biopsy cavity was vacuumed free of blood. A Gel Mark Ultra clip was inserted via the probe and deployed in the biopsy cavity in the usual fashion. The probe was rotated 180 degrees and removed from the breast. The breast was then released from compression and pressure held over the biopsy site till bleeding subsided. It was then dressed with Steri-Strips.
The patient was then recompressed in the cranial to caudal position and scout image was again obtained to identify the clustered calcifications in the retroareolar region. Stereotactic views were obtained and the lesion was targeted and mammographic coordinates were calculated. The breast was again prepped with ChloraPrep and anesthetized with 1% lidocaine. A 3 mm puncture incision was made through which a new 11 gauge Mammotome probe was inserted and directed to the calcifications using the mammographic coordinates. Correction was made on the X-axis and the device was fired. It was noted that there was still a fairly significant X correction and X error. However, sampling was done through the 6 to 12 o’clock position, going through 9 o’clock in an effort to get the calcifications.
Sampling was done through the hands of the clock twice, and these samples were sent for specimen radiography. No calcifications were noted within those samples and the probe was removed from the breast and a stereotactic view was obtained. The calcifications were noted to still be within the breast and approximately 2 cm away from the biopsy cavity. The calcifications were again retargeted and new set of mammographic coordinates were calculated. At this point, the new mammographic coordinates were not within the confines of the breast and it was not felt possible to obtain these calcifications through the craniocaudal approach. Therefore, the needle was removed from the breast and the breast was released from compression. That puncture site was dressed with Steri-Strips and patient was repositioned compressing the breast in a lateral to medial fashion. The cluster of retroareolar calcifications was again identified in the lateral to medial compression on a scout image and stereotactic views were obtained. The lesion was targeted and a new set of mammographic coordinates were calculated. These calculations were well within the breast parenchyma.
A third puncture incision was made after anesthetizing skin again with 1% lidocaine. The probe was then inserted following mammographic coordinates. Prefire images were obtained revealing reasonably good position of the probe. However, a slight correction was made on the Y-axis and the device was fired. Postfire images revealed good position of the probe. The mechanical cutter was then activated. Tissue was cut, excised and transported through the probe. Multiple samplings of tissue were obtained, rotating the thumbwheel two full turns through the hands of the clock. Samples were then sent for specimen radiography, which revealed multiple calcifications within the samples. Probe was backed out of the breast 5 mm and a MicroMark clip was inserted using the probe and deployed in the biopsy cavity in the usual fashion. The probe was rotated 180 degrees and removed from the breast. The second set of samples was sent to pathology for routine examination labeled site B. The breast was then released from compression and pressure held over the biopsy site until bleeding subsided. The third puncture site was then dressed with Steri-Strips as well. The patient was then removed from the table and taken for routine 2-view mammography. The patient tolerated the procedure well and had no immediate complications.
