TY - JOUR
AU - Choudhery, Sadia
AB - Localization, tomosynthesis, axilla A 54-year-old female with biopsy-proven left breast invasive ductal carcinoma and a biopsy-proven metastatic left axillary lymph node marked by a coil-shaped tissue marker underwent neoadjuvant chemotherapy. After neoadjuvant chemotherapy, the left axillary adenopathy had resolved, and the biopsy clip could not be visualized using sonography. To ensure the removal of the malignant lymph node during surgery, a tomosynthesis-guided seed localization of the biopsy clip in the left axilla was performed (Figure 1). The patient had multiple surgical clips in the left axilla from a prior unrelated surgery. Figure 1. Open in new tabDownload slide Tomosynthesis-guided localization of the left axilla. A: A biopsy-proven malignant lymph node in the left axilla is marked with a biopsy marker (circle). The clip, the target in this case, is placed in the center of an alphanumeric grid, and a 3D image is acquired. The coordinates of the clip on the alphanumeric grid are identified. Additionally, the 3D slice number at which the coordinates of the alphanumeric grid are most in focus and the 3D slice number at which the biopsy clip is best visualized are noted. These two slice numbers are then subtracted to yield the depth of the needle. B: The needle tip is at the targeted clip in the left axilla (circle). The needle is placed along the coordinates identified on the alphanumeric grid at the depth calculated previously. If a node is thought to be deep to the pectoralis muscle, the needle tip is placed a few millimeters deeper than the calculated depth to avoid placement of the seed in the pectoralis. Once the needle tip is identified to be at the target, the radioactive seed is deployed. C: The postlocalization mammogram demonstrates that the radioactive seed is adjacent to the biopsy marker (circle) in the left axilla. D: specimen radiograph documents removal of the lymph node, radioactive seed, and biopsy marker. Figure 1. Open in new tabDownload slide Tomosynthesis-guided localization of the left axilla. A: A biopsy-proven malignant lymph node in the left axilla is marked with a biopsy marker (circle). The clip, the target in this case, is placed in the center of an alphanumeric grid, and a 3D image is acquired. The coordinates of the clip on the alphanumeric grid are identified. Additionally, the 3D slice number at which the coordinates of the alphanumeric grid are most in focus and the 3D slice number at which the biopsy clip is best visualized are noted. These two slice numbers are then subtracted to yield the depth of the needle. B: The needle tip is at the targeted clip in the left axilla (circle). The needle is placed along the coordinates identified on the alphanumeric grid at the depth calculated previously. If a node is thought to be deep to the pectoralis muscle, the needle tip is placed a few millimeters deeper than the calculated depth to avoid placement of the seed in the pectoralis. Once the needle tip is identified to be at the target, the radioactive seed is deployed. C: The postlocalization mammogram demonstrates that the radioactive seed is adjacent to the biopsy marker (circle) in the left axilla. D: specimen radiograph documents removal of the lymph node, radioactive seed, and biopsy marker. Conflict of interest statement None declared. © Society of Breast Imaging 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - Tomosynthesis-Guided Seed Localization of the Axilla
JF - Journal of Breast Imaging
DO - 10.1093/jbi/wby007
DA - 2019-03-13
UR - https://www.deepdyve.com/lp/oxford-university-press/tomosynthesis-guided-seed-localization-of-the-axilla-aQppNtHQb5
SP - 74
EP - 74
VL - 1
IS - 1
DP - DeepDyve
ER -