This document provides information on interventional mammography procedures. It discusses what interventional procedures are and different types of breast biopsies including needle biopsies and open biopsies. Specific procedures covered include standard lesion localization, stereotactic lesion localization, ultrasound-guided biopsies, cyst aspirations, fine-needle aspiration biopsies, pneumocystography, and galactography. Maintaining sterile technique is emphasized when performing these minimally invasive diagnostic and treatment methods.

1. INTERVENTIONAL
MAMMOGRAPHY
PRESENTED BY-
AHSHAN KHAN
BRIT 3RD YEAR

2. WHAT IS INTERVENTIONAL
• A subspecialty which provides minimally
invasive techniques with the help of imaging
modalities to diagnose or treat a condition.
• Minimally invasive
• Local anesthesia

3. INVASIVE
• A medical procedure that invades (enters) the
body, usually by cutting or puncturing the skin
or by inserting instruments into the body.

4. NON INVASIVE
• A medical procedure is defined as non-
invasive when no break in the skin is created
and there is no contact with the mucosa, or
skin break, or internal body cavity beyond a
natural or artificial body orifice. For example
examination of the ear-drum or inside the
nose or a wound dressing change all fall
outside the definition of non-invasive
procedure.

5. INTERVENTIONAL RADIOLOGY
• Stent placement
• Embolization
• Thrombolysis
• Balloon angioplasty
• Atherectomy
• Electrophysiology
• Percutaneous biopsy
• Abscess drainage
• Percutaneous nephrostomy
• Percutaneous Biliary drainage

6. Mammography Interventional
Procedures
• Used to:
• Locate an area of interest
• Place a radiopaque marker for a open surgical
biopsy (wire localization)
• Sample tissue or cells

7. WHAT IS MAMMOGRAPHY
• Mammography is a special type of imaging
technique to demonstrate the breast and
surrounding structure with the help of the
xrays.

8. Interventional
Procedures
• Sterile Technique
• Standard lesion localization
• Biopsy
• Stereotactic lesion localization
• Ultrasound
• Cyst aspirations and fine-needle aspiration
biopsies
• Pneumocystography
• Galactography

9. The way of
spread infection
Spread of infection:
• Exogenous: infection introduced to the patient
from outside the body.
• Endogenous: infection introduced to the patient
from within the body.
• Iatrogenic: the condition of the patient is
influenced by the physician’s actions.
• Nosocomial: an infection obtained by a patient
within the hospital setting.

10. Sterile Technique
• Preparation of local anesthetics, contrast
media, etc. is very important.
• Sterile technique must be used when
drawing up these agents.
• The expiry date must be checked, along
with the integrity of the contents being
used.

11. Sterile Technique
• Proper glove usage is also very important.
• Sterile gloves must be used when preparing
a sterile tray, for the procedure.
• Sterile gloves must also be used during the
procedure, if an injection, or puncture into
the skin is performed.
• Utility gloves may be used when disposing
of the tray and the instruments.

12. Sterile Technique
Skin preparation:
• Any invasive procedure requires proper skin
preparation.
• This involves using a betadine/providine
prep on the patient’s skin.
• Make sure to use proper sterile technique,
cleaning from the injection site first to the
periphery, in a spiral fashion.

13. Sterile Technique
Sterile tray preparation may include:
• Gauze
• Betadine
• Local anesthetic agent
• Syringe(s)
• Needle(s)
• Scalpel
• Suture
• Contrast medium
• Sterile towels

14. Standard Lesion Localization
• Placement of a wire inside of the patient’s
breast to help the surgeon locate and
remove the lesion.
• Sterile technique is used to insert a needle in
the patient’s breast, with the guidance of a
specialized mammography paddle, with
numbers and letters to designate the location
of where the wire should be placed.
• The radiologist or surgeon will typically
perform this procedure, with the assistance of
a mammographer.

15. Standard Lesion Localization
• Localization
paddle

20. WHAT IS BIOPSY?
• Indicates removal of tissue from a living body
for microscopic diagnostic examination Most
precise and accurate
• Primary purpose: determine the diagnosis
precisely for proper treatment
• Should always be used to verify presence and
nature of neoplastic disease
• More likely to rule out malignancy than to
diagnose cancer.

21. TYPES OF BREAST BIOPSIES
There are two main types of biopsies:
Needle Biopsy
Open Biopsy
The choice for biopsy are determined by
whether the lump is palpable (can be felt) or non-
palpable (can not be felted), the location of the
lump and the woman’s general health.

22. NEEDLE BIOPSY
 Aneedle biopsy is a procedure that uses a
needle to remove tissue or cells from the
breast.
There are two types of needle biopsies:
1.Fine Needle
2.Core Needle Biopsy

23. NEEDLE BIOPSIES
 Fine Needle – Athin, hollow needle is used to
remove a sample of tissue. The procedure is
quick and can be done in a doctor’s office.
 Core Needle – Alarger needle is inserted
through a small incision in the skin, and a small
core of tissue is removed. This type of needle
biopsy is done with the assistance of
mammography or ultrasound imaging in a
doctor’s office or hospital outpatient clinic.

24. ADVANTAGES OF NEEDLE
BIOPSIES
 Simple procedure – does not require surgery
 Accurate
 Quick – only takes a few minutes
 Not painful
 Inexpensive
 Quick results

25. DISADVANTAGES OF
NEEDLE BIOPSIES
 Entire lump is not removed
 Open biopsy may be necessary
For Fine Needle Only:
 Specialist needed to read results
 In situ cancer not distinguishable from invasive
cancer

26. OPEN BIOPSIES
 An open biopsy is a surgical procedure that
opens the breast to remove tissue.
There are two types of open biopsies:
Incisional and Excisional

27. ADVANTAGES OF OPEN
BIOPSIES
• Quick – takes only one hour
• More accurate than a needle biopsy
• Larger samples provide information for
treatment plan
•Excisional Only:
• Removes entire lump
• Maybe the only surgical treatment needed

28. DISADVANTAGES OF OPEN
BIOPSIES
 Surgical procedure
 Expensive
 Side effects such as infection or blood collection
under the skin
Excisional Only:
 Removing tissue can change the look and feel of
the breast

29. IMAGING TECHNIQUES
When a lump cannot be felt, the doctor must
locate it with a special imaging technique.
 The doctor may use mammography (sometimes
called stereotactic localization) or ultrasound
imaging
 The lump is located by mammography or
ultrasound
 The doctor inserts a needle to collect a sample
of tissue

30. Female breast
The female breast
is either of two
mammary glands
(organs of milk
secretion) on the
chest.

31. Needle biopsy of the breast
Aneedle biopsy is performed
under local anesthesia. Simple
aspirations are performed
with a small gauge needle to
attempt to draw fluid from
lumps that are thought to be
cysts. Fine needle biopsy uses
a larger needle to make
multiple passes through a
lump, drawing out tissue and
fluid. Withdrawn fluid and
tissue is further evaluated to
determine if there are
cancerous cells present.

32. Open biopsy of the breast
An open biopsy can be
performed under local
or general anesthesia
and willleave a small
scar. Prior to surgery, a
radiologist often first
marks the lump with a
wire, making it easier for
the surgeon to find.

33. Lumpectomy
Lumpectomy is a surgical
procedure performed on a
solid breast mass to
determine if it is malignant.
The suspicious lump and
some surrounding tissue is
excised and analyzed.

34. Stereotactic Biopsy
• Stereotactic localization is followed by a biopsy
procedure, typically either a fine-needle aspiration
or core needle biopsy.
• Needle biopsies of palpable breast lesions do not
require stereotactic localization.
• Stereotactic breast biopsy is a radiological
technique for localizing breast lesions for biopsy by
either fine-needle aspiration or core needle biopsy.
• The technique requires that the breast be
compressed between a compression paddle and an
image receptor.

35. Stereotactic Lesion Localization
• Sterile technique is used to perform this procedure.
• Both, the radiologist and mammographer are
present, and sometimes a third person is available
to take specimen radiographs.
• Stereotactic breast biopsies are very accurate
procedures. They are less invasive than open
surgery, but they are still considered invasive.
• A computer is used to calculate the depth of the
lesion stereotactically (15 degrees (+) and 15
degrees (-)), and a small core biopsy is performed,
while the breast is in compression, with its
guidance.

36. Prone Stereotactic Biopsy

37. Stereotactic Table

38. Stereotactic Table

39. Biopsy Mechanism

40. Biopsy Mechanism

41. Biopsy Mechanism

42. Digitizer Tablet

44. Ultrasound
• Ultrasonography can be used to perform breast
biopsies, or fine-needle aspirations.
• Sound waves are used to see a mass or lesion in
breast tissue. The radiologist will use a transducer
to guide him to where the lesion is, and then he
will place a needle into the breast to biopsy the
tissue.
• In this procedure, the patient’s breast does not
need to be compressed, as in a stereotactic biopsy.

45. Cyst Aspirations and Fine-needle
Aspiration Biopsies
• These procedures are performed on patients who have
been diagnosed with cysts.
• Painful cysts will be drained using a fine-needle
technique either by palpation, or with ultrasound
guidance.
• Sterile technique is observed in these procedures.
• After the fluid has been withdrawn, the fluid is sent off
to pathology for diagnosis.
• Cells can be malignant, if the patient is diagnosed with
having a complex cyst (not completely fluid filled).
• Simple cysts could reoccur after their drainage.

46. Pneumocystography
• This procedure is performed after a cyst
has been drained. The same amount of air
is injected, after the fluid is withdrawn
and a radiograph is taken.
• This procedure is performed to see if a
tumor is present, where the fluid was
found.

47. Galactography
• Galactography or ductography is a medical
diagnostic procedure for viewing the milk ducts
• This procedure is performed on patients who
have a discolored or bloody discharge, coming
from the nipple.
• A very small catheter is placed inside the duct
where the discharge is evacuating. Contrast
medium is injected, and a radiograph is taken to
see if there is a tumor present.