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CHAPTER 19

CHAPTER 19. Diagnostic Procedures. PREOPERATIVE LOCALIZATION. Screening mammography allows us to see the lesion before it can be felt. Surgeon needs help locating these nonpalpable lesions. PREOPERATIVE LOCALIZATION. Examples of wire localization sets.

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CHAPTER 19

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  1. CHAPTER 19 Diagnostic Procedures

  2. PREOPERATIVE LOCALIZATION • Screening mammography allows us to see the lesion before it can be felt. • Surgeon needs help locating these nonpalpable lesions.

  3. PREOPERATIVE LOCALIZATION • Examples of wire localization sets Hook at end of the wire-localization needle is firmly anchored into tissue near ROI

  4. PREOPERATIVE LOCALIZATION • Radiologist determines how the patient is positioned. • Aim: Shortest skin to lesion presentation

  5. PREOPERATIVE LOCALIZATION • For ROI in upper half of breast, CC is most common approach.

  6. PREOPERATIVE LOCALIZATION • For ROI in LIQ, ML is most common approach.

  7. PREOPERATIVE LOCALIZATION • For ROI in LOQ, LM is most common approach.

  8. PREOPERATIVE LOCALIZATION • Remember to deactivate the automatic compression release before procedure begins … and re-engage when finished.

  9. SPECIMEN RADIOGRAPHY • Calcium: Always • Mass lesion: May/may not • Magnify for easier viewing

  10. SONOGRAPHIC IMAGING • Primarily distinguishes cystic from solid

  11. SONOGRAPHIC IMAGING • If the lesion is a cyst, echoes first appear in the part of the cyst closest to the transducer.

  12. SONOGRAPHIC IMAGING • With a soft tissue mass, a sprinkling of echoes throughout the entire mass suddenly appears.

  13. BREAST ULTRASOUND PERFORMED BY: • Radiologist • US technologist • Specially trained mammography technologist

  14. CYST ASPIRATION • If large or painful

  15. DUCTOGRAM • For unilateral, spontaneous nipple discharge

  16. FNAC • Fine needle aspiration cytology

  17. SELECTIVE USE FOR ACCURATE RESULTS • Physician must be skilled at needle placement. • Physician skilled in slide preparation • Specially trained pathologist required.

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