0:00

Lesions that are deep, particularly when they're close

0:03

to the chest wall, can be particularly challenging.

0:07

I really like using vacuum assisted devices

0:10

to biopsy these deep lesions.

0:12

I find they're, um, a very safe

0:15

and effective means of biopsying them.

0:17

Very quick, and I highly recommend that you try this.

0:20

So what am I gonna do? So I'm going to insert the vacuum

0:25

assisted device at a, uh, relatively steep angle.

0:29

You can see these devices very well, um,

0:32

because they're a, a larger bore.

0:34

And you can also use heel toe maneuvers

0:37

as we described previously to help, um,

0:39

see them if you have any trouble.

0:41

So it's gonna, I'm gonna insert it down so that the tip

0:44

of the needle is immediately below the lesion.

0:49

At that point, I'm then going to lever the device down,

0:54

flatten my hand out.

0:56

Um, it's gonna look something like this.

0:58

It's a little bit difficult to demonstrate so

1:00

that now the tip is beyond the lesion.

1:03

Again, keeping a very close eye on it.

1:05

This is very easy to do. And then open the chamber.

1:09

You can see it's within it,

1:10

and I'm gonna be taking my biopsies

1:12

immediately anterior to it.

1:14

Now, as we describe

1:15

before, when we talk about vacuum devices, you've got

1:18

to make sure that you have adequate anesthesia, um, behind

1:23

and beyond that lesion before you do these biopsies.

1:28

And here's a biopsy clip

1:29

where I've done this, um, in the patient.

1:31

I've, I've followed the exact technique I showed before,

1:34

and you can see I'm very successfully biopsying this deep

1:37

lesion if you don't have the advantage of access

1:41

to a vacuum assisted needle.

1:43

Just to remind you of some

1:45

of the techniques we described in earlier video sections

1:48

to be able to access these safely.

1:50

Uh, so entering your needle further from the transducer,

1:55

so maybe not at the transducer edge, but maybe two

1:58

or three centimeters further away.

2:01

Um, very carefully observing your biopsy angles

2:04

and your stroke throat, increasing the pressure

2:07

of the transducer to reduce the depth

2:09

of the breast using L-shaped paths.

2:13

And you may, of course, need a longer needle to be able

2:16

to get adequate anesthesia at the biopsy site.

2:19

Again, reiterate,

2:20

your patient should not be in pain when you're doing

2:23

biopsies.