0:00

Alright, we're just gonna very quickly, we're going to do,

0:03

um, five quiz cases to see

0:07

if you can work out which technique modification

0:10

that you are going to do to optimize biopsy

0:13

of some challenging lesions.

0:14

And so the options you're gonna be given,

0:16

and these will come up to you on the pole,

0:18

is roll the lateral side up, roll the medial side up,

0:22

put the biopsy needle in deeper into the breast than you

0:26

normally would use a petite needle pad,

0:29

the rich raviola area,

0:31

or increase the compression

0:33

of the patient, the patient's breast.

0:35

Okay, so here's quiz lesion one.

0:41

So, um, roll lateral side up is probably not gonna help us

0:45

much in this because we're going to, you know,

0:48

we can get at this lesion, okay?

0:50

It's just, it's really superficial.

0:52

So this problem is a superficial lesion

0:54

and the same problem medial side up is not gonna help us in

0:58

this case.

1:00

Are we going to insert the biopsy needle through?

1:02

Now that is certainly one of our options

1:04

and that would be the option that I would probably use

1:07

'cause she's got a nice, um, you know,

1:10

she has a large enough breast, we have plenty of tissue

1:12

and I can just put that regular two chamber, um, needle in,

1:16

have my chamber a little deeper than usual with the lesion,

1:19

the proximal end of the chamber.

1:20

And that's gonna work fine.

1:22

But a totally um,

1:23

appropriate thing is use a petite needle

1:25

if that's what you prefer doing.

1:26

Okay, let's go to the next one.

1:28

So most people voted for pad, the retro area area,

1:31

and that's what I would do.

1:33

I'd put the padding in, it's going to squish it.

1:36

Uh, we're probably gonna come from this side, it's going

1:38

to squish it up against the grid a little bit better.

1:42

I would put my needle in so that I skim, um,

1:46

towards the nipple side of this lesion

1:48

and be biopsying backwards.

1:51

All right, so our problem here is

1:53

that this is a very postal lateral lesion.

1:56

So let's see what people wanted to do for that.

2:00

Okay, well if you roll your lateral side of the breast up,

2:04

you are gonna pull that out of the grid.

2:08

Okay, so you, you want to be rolling the lateral side down.

2:12

So actually rolling the medial side up.

2:15

So the 37% got this, you wanna roll this side down

2:20

by bulking up this side of the patient, the medial side.

2:23

So you're gonna be rolling them that way if you like.

2:26

Okay, next case. So this is the opposite thing.

2:30

So you want to get this medial side down,

2:33

and you do that by rolling the lateral side up

2:36

and putting them up a little bit so that you're,

2:39

you're putting a wedge under the ipsi lateral shoulder.

2:43

Okay. And one, one more question

2:46

and there's a clue at the top there.

2:50

So this is a diagnostic study

2:53

and another clue here is this is just look at the size

2:56

of the nipple compared to the rest of the

2:58

Brass.

3:01

Well, it's interesting selection of choices here.

3:04

So, um, insert biopsy needle deeper

3:07

because it's a superficial lesion

3:10

is something I would do if I had a large enough breast.

3:12

But see how this is a four centimeter breast

3:14

before it has compression on.

3:16

So this four centimeter is probably gonna be a two

3:20

and a half to three centimeter breast with compression on.

3:23

You can see the, the relative size of the nipple

3:25

to the breast shows how small this lady's breasts are.

3:29

So if we do that, we're going to be running into trouble

3:31

because we're gonna run,

3:33

we're gonna make little holes

3:34

in the breast on the other side.

3:36

So that's not work. Use petite needle is

3:39

what I would do here.

3:40

This is a real good case for petite needle.

3:43

Increased compression is gonna make the breast even thinner.

3:47

So if we have a problem with the thin breast

3:49

and problems with superficial lesions,

3:51

we squish 'em even harder, they're gonna be even thinner

3:53

and we're gonna run into more problems.