0:01

Once the, uh, patient is anesthetized

0:04

and we've repeated imaging, we go ahead

0:06

and advance the needle to the satisfactory target

0:10

of X, Y, and Z.

0:12

Sometimes I make a skin Nick, if I feel that it's going

0:16

to be challenging to advance the needle, for example, in a

0:20

more, uh, anterior location near the nipple

0:23

where there isn't good compression, it may be harder

0:26

to get the needle into the breast,

0:28

so I may make a skin nick to make that easier.

0:32

Some cases I omit the pre

0:34

and post-fire imaging with experience.

0:37

I found that these are not always necessary

0:40

and they do take time and they increase radiation dose.

0:45

So I may skip the pre-fire and

0:48

or the post-fire imaging if I feel comfortable, um,

0:52

that I'm in the right place.

0:53

The target is large enough that I feel that if there's

0:57

a slight movement with lidocaine, it's not going to make

1:00

that much of a difference

1:01

regarding success of the procedure.

1:05

Then we go ahead and sample, depending upon the size

1:08

of the target and

1:09

where the needle is relative to the target.

1:12

I may go around in a circle

1:14

or I may, uh,

1:16

preferentially sample in one particular

1:18

direction from the needle.

1:22

Here are the samples again being collected in the

1:24

chamber attached to the needle.

1:27

We divide our specimens into the core biopsy tray.

1:32

We can see on our specimen radiograph

1:35

that we have representative calcifications here.

1:39

The reason that we use this tray is our pathologists

1:44

like to separate the cores

1:46

with calcifications from those without.

1:49

They do look at everything under the microscope.

1:51

However, knowing which cores have the mammographically

1:56

significant calcifications is helpful for them

1:59

as they do their own rad path correlation.

2:02

So we look at this specimen radiograph

2:04

and say, okay, 12 o'clock, nine o'clock, those are going

2:07

to go into container number one and the rest in three

2:10

and six and the center are going into container number two.

2:15

The needle is then, uh, withdrawn from the breast

2:19

and there's a sheet that remains at the target

2:22

through which we can place the clip introducer

2:26

and deploy the clip.

2:30

Repeat imaging here confirms that the clip has been deployed

2:34

after the clip has been deployed

2:36

and everything is removed from the breast.

2:38

We hold pressure for about five minutes

2:41

to obtain hemostasis.

2:43

Some patients require a little bit longer depending upon,

2:46

uh, whether or not they've been on any blood thinners.

2:49

Um, but typically five minutes or so is enough.

2:52

We put Steri strips over the needle entry site

2:56

and with a bandaid over thei strips.

2:59

When I'm holding pressure, I use that opportunity

3:03

to go over the post-care instructions.

3:06

So we talk about what to expect, um,

3:08

how should they should take care of the breast, uh,

3:11

what they should do if they have pain, et cetera.

3:14

We give these instructions to the patient, uh, in writing,

3:17

but it's helpful to go over them in advance.

3:20

So if the patient has any questions,

3:22

they can ask them right then and there.

3:24

I then tell the technologist which views I want

3:27

for the post biopsy mammogram, whether I want 2D, uh,

3:32

do I want tomosynthesis, do I want modified views such

3:35

as an XCCL?

3:37

Sometimes we look at those images

3:39

before the patient leaves the department,

3:42

but sometimes we'll just tell the technologist.

3:44

As long as you see a ribbon clip on both views,

3:47

you can discharge the patient.

3:48

We don't need to look at the images before she leaves.

3:51

So the post biopsy mammogram is important

3:55

to know if the clip is at the target site and whether

3:58

or not there are residual, uh, calcifications

4:01

or residual target if it's noncalcified.

4:04

So here, uh, pre and post cc, pre and post ml,

4:09

and the clip is at the target on both views

4:11

and there are no residual calcifications.