0:00

Challenge number 12.

0:03

Okay, so this is the lesion in this patient

0:06

before on the diagnostic study.

0:09

This is the right CC mammogram after the biopsy.

0:12

And you can see the clip is way out medial here,

0:16

let me just turn this thing so you can see, you know,

0:19

here's our biopsy site.

0:21

We came from a lateral approach as you,

0:23

you know, it's right in the middle.

0:24

So lateral's still gonna be easier

0:26

and yet our clip ends up miles away medially.

0:30

And funny enough, when these clips migrate as such,

0:33

I mean they don't actually get up legs and walk.

0:35

Um, it's usually

0:36

that they end up being too deep in the breast.

0:38

Sometimes they pull out with the biopsy device

0:41

and the cannula, but most times

0:43

they actually end up too deep.

0:44

And it's probably

0:45

because, um, this is a fairly fatty breast, um,

0:49

it probably compressed quite a lot.

0:51

You ended up with a fairly big cavity

0:53

and that that clips stuck

0:55

to the posterior aspect of the cavity.

0:57

But this is obviously a significant problem.

0:59

If this was a malignant lesion, it turned out not to be

1:02

and it need to be removed

1:04

because you have nothing much else

1:05

to be able to target from.

1:07

So what can we do in this case?

1:09

And again, it's probably partially because of hematomas

1:12

and larger cavity sizes.

1:13

Definitely see it more in fatty breast.

1:16

Well, one challenge is that we actually don't usually image

1:19

after placing the clip

1:21

because we found there's so much air, um, biomark, um,

1:24

because there's so much air and blood there.

1:26

You can try imaging after the clip, uh, placement,

1:29

but we usually find it's not particularly helpful at all.

1:32

We do take them to have a mammogram afterwards.

1:35

I have reduced the instance of this

1:37

by pulling my introducer back five millimeters

1:40

before I deploy the clip.

1:41

And as worth drying, if you're finding you're having a lot

1:44

of issues with deep deployment

1:46

and if you find on the post, um, biopsy mammogram that

1:50

that clip has indeed, um, shot miles away, then

1:56

consider trying to replace it blindly.

1:58

So you take the patient into ultrasound, you can look

2:01

and see if you see the cavity

2:02

and just use one of the ultrasound, um, clips

2:06

to place it through the biopsy tracks just straight in.

2:09

Usually everything's a ized up already.

2:11

You just need to clean the breast up a bit into

2:13

that biopsy cavity.

2:15

Or sometimes I've even sort of just tried to calculate out

2:18

where I knew it was from the diagnostic study.

2:21

So I know it's five centimeters under the skin, for example,

2:24

and just put it in free hand on the ultrasound table.

2:27

And, um, surprisingly enough that works most times.