ULTRASOUND GUIDED INTERVENTIONAL PROCEDURES

Several methods of breast biopsy now exist. The most appropriate method of biopsy for a patient depends upon a variety of factors, including the size, location, appearance and characteristics of the breast abnormality.
Ultrasound is an important guide to many diagnostic and interventional procedures of the breast.
Procedures done using Ultrasound:
  • Cyst aspiration
  • Fine needle aspiration cytology- FNAC
  • Drainage procedures
  • Preoperative needle wire localization for surgical excision
  • Large core needle biopsy
  • Vacuum assisted needle biopsy
  • Sentinel node biopsy



CYST ASPIRATION


§ Simple non invasive procedure

§ A small needle is used drain a simple cyst of the breasts

§ Usually does not require anesthetic

§ Eases symptoms when the lesion is large painful and uncomfortable

§ Cost effective

§ Fluid is usually not sent for analysis

§ Determine if the lesion is complex, solid or truly cystic and if further investigation is necessary

external image cyst_aspiration_2.jpg


FINE NEEDLE ASPIRATION CYTOLOGY


§ Fairly simple procedure

§ A 22 or 25 gauge needle is used (smaller than the needle used for blood draws)

§ The intent is to harvest individual cells from the lesion for analysis

§ A vacuum is created with a syringe and multiple in and out motions of the needle are performed

§ Requires several insertions to ensure adequate specimen

§ The harvested samples are then sent to pathology for examination

§ Inadequate specimen and therefore inaccuracy in diagnosis is the greatest disadvantage

DRAINAGE PROCEDURES
Ultrasound is sometimes used in drainage lesions such as an abscess, hematoma or seroma.
Drainage of a breast lesion is similar to a Cyst aspiration except that a larger needle is used due to the fact that the lesions contain a thicker fluid, sometimes even debris and have a more fibrous capsule than a simple cyst.


PREOPERATIVE NEEDLE WIRE LOCALIZATION
  • Ultrasound offers a quick and accurate method for placement of percutaneous needle wire prior to a surgical excision of a breast lesion.
  • It is also an invaluable method for localization of breast lesions that are not easily approached by mammography and non palpable lesions
  • Assists the surgeon in locationg the area of concern
Needle Designed To Pinpoint A Suspicious Lesion Within The Breast Tissue To Be Biopsied
Needle Designed To Pinpoint A Suspicious Lesion Within The Breast Tissue To Be Biopsied



LARGE CORE NEEDLE BIOPSY
§ Used for patients with solid and larger breast masses (palpable) § The needle used during core needle biopsy is larger than the needle used with FNA, usually a 16, 14, or 11 gauge § An automated instrument/ biopsy needle is used and one sample is obtained with one insertion § Three to six separate core needle insertions are typically needed to obtain a sufficient sample of breast tissue § Patients may experience a slight pressure during core needle biopsy but should not experience any significant pain. § As tissue samples are taken, clicks may be heard from the needle and sampling instrument. § The samples are then sent to the pathology laboratory for diagnosis.
 Ultrasound Guided Core Needle Biposy
Ultrasound Guided Core Needle Biposy



VACUUM ASSISTED BREAST BIOPSY
§ A minimally invasive procedure that allows for the removal of multiple tissue samples at one time.§ Uses a special biopsy probe that is inserted only once into the breast through a small nick made in the patient's breast. § A large core biopsy needle with a special cutting blade is used which permits for easier insertion. § The opening of the needle through which the samples are obtained is located on the side of the needle. § Once the sample is located, the vacuum pulls the tumor into the opening of the needle and a rotating cutting blade slices the tissue. § The obtained tissue sample goes into a special chamber in the probe from where it can be obtained by the physician without removing the needle (probe). § Eight to ten samples of breast tissue are taken 360 degrees around the lesion. § Small masses may even be removed completely using this type of procedure.




SENTINEL LYMPH NODE BIOPSY

§ Procedure done to determine if the breast cancer has spread to surrounding lymph nodes.

§ Performed to stage breast cancer and to determine treatment options

§ A sentinel lymph node is the first lymph node into which a tumor drains. ( Def. Sentinel=one that stands watch)

§ To identify the sentinel lymph node, the surgeon injects a radioactive substance, blue dye (Technetium 99m ) near the tumor.

§ A scanner is used to find the sentinel lymph nodes containing the radioactive substance or looks for the lymph node stained with dye.

§ Once located the lymph node is removed (one or more nodes may be removed)

§ The sentinel node is checked for the presence of cancer cells by a pathologist.

§ A great advantage is that SLN biopsy is less invasive with a short recuperation time.

§ A negative biopsy indicates a >95% chance that remaining lymph nodes are also cancer free.

§ Reduces the need to undergo full axillary lymph node dissection and the the risks and long term complications associated with it.