ULTRASOUND+GUIDED+INTERVENTIONAL+PROCEDURES

//__**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

<span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: normal; margin: 0in 0in 0pt 0.5in; text-indent: -0.25in;">§ Cost effective

<span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: normal; margin: 0in 0in 0pt 0.5in; text-indent: -0.25in;">§ Fluid is usually not sent for analysis

<span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: normal; margin: 0in 0in 10pt 0.5in; text-indent: -0.25in;">§ Determine if the lesion is complex, solid or truly cystic and if further investigation is necessary

<span style="background-color: #ffffff; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">

<span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">**__FINE NEEDLE ASPIRATION CYTOLOGY__**

<span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: normal; margin: 0in 0in 0pt 38.25pt; text-indent: -0.25in;">§ Fairly simple procedure

<span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: normal; margin: 0in 0in 0pt 38.25pt; text-indent: -0.25in;">§ A 22 or 25 gauge needle is used (smaller than the needle used for blood draws)

<span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: normal; margin: 0in 0in 0pt 38.25pt; text-indent: -0.25in;">§ The intent is to harvest individual cells from the lesion for analysis

<span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: normal; margin: 0in 0in 0pt 38.25pt; text-indent: -0.25in;">§ A vacuum is created with a syringe and multiple in and out motions of the needle are performed

<span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: normal; margin: 0in 0in 0pt 38.25pt; text-indent: -0.25in;">§ Requires several insertions to ensure adequate specimen

<span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: normal; margin: 0in 0in 0pt 38.25pt; text-indent: -0.25in;">§ The harvested samples are then sent to pathology for examination

<span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: normal; margin: 0in 0in 10pt 38.25pt; text-indent: -0.25in;">§ Inadequate specimen and therefore inaccuracy in diagnosis is the greatest disadvantage

<span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">**__DRAINAGE PROCEDURES__** <span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Ultrasound is sometimes used in drainage lesions such as an abscess, hematoma or seroma. <span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">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**.**

<span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">**__PREOPERATIVE NEEDLE WIRE LOCALIZATION__** <span style="background-color: #ffffff; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">
 * <span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Ultrasound offers a quick and accurate method for placement of percutaneous needle wire prior to a surgical excision of a breast lesion.
 * <span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">It is also an invaluable method for localization of breast lesions that are not easily approached by mammography and non palpable lesions
 * <span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Assists the surgeon in locationg the area of concern

<span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; margin: auto 0in auto 38.25pt; text-indent: -0.25in;">**__L____ARGE CORE NEEDLE BIOPSY__** <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; font-weight: normal; margin: auto 0in auto 38.25pt; text-indent: -0.25in;">§ Used for patients with solid and larger breast masses (palpable) <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; font-weight: normal; margin: auto 0in auto 38.25pt; text-indent: -0.25in;">§ The needle used during core needle biopsy is larger than the needle used with FNA, usually a 16, 14, or 11 gauge  <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; font-weight: normal; margin: auto 0in auto 38.25pt; text-indent: -0.25in;">§ An automated instrument/ biopsy needle is used and one sample is obtained with one insertion  <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; font-weight: normal; margin: auto 0in auto 38.25pt; text-indent: -0.25in;">§ Three to six separate core needle insertions are typically needed to obtain a sufficient sample of breast tissue  <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; font-weight: normal; margin: auto 0in auto 38.25pt; text-indent: -0.25in;">§ Patients may experience a slight pressure during core needle biopsy but should not experience any significant pain. <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; font-weight: normal; margin: auto 0in auto 38.25pt; text-indent: -0.25in;">§ As tissue samples are taken, clicks may be heard from the needle and sampling instrument. <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; font-weight: normal; margin: auto 0in auto 38.25pt; text-indent: -0.25in;">§ The samples are then sent to the pathology laboratory for diagnosis. <span style="background-color: #ffffff; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">

<span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">__**VACUUM ASSISTED BREAST BIOPSY**__ <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; font-weight: normal;">§ A minimally invasive procedure that allows for the removal of multiple tissue samples at one time. <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; font-weight: normal;">§ Uses a special biopsy probe that is inserted only once into the breast through a small nick made in the patient's breast. <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;"> § A large core biopsy needle with a special cutting blade is used which permits for easier insertion. <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; font-weight: normal;">§ The opening of the needle through which the samples are obtained is located on the side of the needle. <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; font-weight: normal;">§ Once the sample is located, the vacuum pulls the tumor into the opening of the needle and a rotating cutting blade slices the tissue. <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; font-weight: normal;">§ 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). <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; font-weight: normal;">§ Eight to ten samples of breast tissue are taken 360 degrees around the lesion. <span style="display: block; margin: auto 0in auto 38.25pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"><span style="background-color: #ffffff; color: #008080; font-family: Arial,Helvetica,sans-serif; font-size: 120%; font-weight: normal;">§ Small masses may even be removed completely using this type of procedure.

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<span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">**__SENTINEL LYMPH NODE BIOPSY__**

<span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">§ Procedure done to determine if the breast cancer has spread to surrounding lymph nodes.

<span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">§ Performed to stage breast cancer and to determine treatment options

<span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">§ A sentinel lymph node is the first lymph node into which a tumor drains. ( Def. Sentinel=one that stands watch)

<span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">§ To identify the sentinel lymph node, the surgeon injects a radioactive substance, blue dye (Technetium 99m ) near the tumor.

<span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">§ A scanner is used to find the sentinel lymph nodes containing the radioactive substance or looks for the lymph node stained with dye.

<span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">§ Once located the lymph node is removed (one or more nodes may be removed)

<span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">§ The sentinel node is checked for the presence of cancer cells by a pathologist.

<span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">§ A great advantage is that SLN biopsy is less invasive with a short recuperation time.

<span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">§ A negative biopsy indicates a >95% chance that remaining lymph nodes are also cancer free.

<span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">§ Reduces the need to undergo full axillary lymph node dissection and the the risks and long term complications associated with it.

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