Needle localized biopsy

a. Under mammographic guidance, a needle and hookwire are placed into the breast parenchyma adjacent to the lesion. The patient is taken to the operating room along with mammograms for an excisional breast biopsy.

b. The skin and underlying tissues are infiltrated with 1% lidocaine with epinephrine. For lesions located within 5 cm of the nipple, a periareolar incision may be used or use a curved incision located over the mass and parallel to the areola. Incise the skin and subcutaneous fat, then palpate the lesion and excise the mass.

c. After removal of the specimen, a specimen x-ray is performed to confirm that the lesion has been removed. The specimen can then be sent fresh for pathologic analysis.

d. Close the subcutaneous tissues with a 4-0 chromic catgut suture, and close the skin with 4-0 subcuticular suture.

D. Ultrasonography. Screening is useful to differentiate between solid and cystic breast masses when a palpable mass is not well seen on a mammogram. Ultrasonography is especially helpful in young women with dense breast tissue when a palpable mass is not visualized on a mammogram. Ultrasonography is not used for routine screening because microcalcifications are not visualized and the yield of carcinomas is negligible.

References: See page 184.

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