Posted By Lucía Graña López

A 68-year-old woman underwent a percutaneous stereotactic-guide core needle biopsy for a cluster of indeterminate calcifications and associated density localized at 3 o`clock in the left breast (Fig 1). The breast was entirely fatty. The biopsy was performed under stereotactic guidance in a 90-degree lateral approach by using a 10-gauge vacuum-assisted biopsy device (EnCor ®, SenoRx, Tempe, USA). Twelve samples were taken and removal of calcifications was confirmed with a radiograph of the specimen. After applying vacuum suction, a metal clip (Gel Mark Ultra, EnCor ®, SenoRx, Tempe, USA) was placed through the probe. Postprocedural stereotactic image obtained showed the clip to be within 6 mm of the center of the biopsy site, where a small hematoma was present (Fig 2). The patient reported bleeding at the biopsy site during the following days. Histology revealed infiltrating ductal carcinoma and surgical excision was recommended. Two months after the vacuum-assisted biopsy, mammography was performed in the craniocaudal and lateral views prior to a hookwire placement for surgical lumpectomy. A small hematoma at the biopsy site was noted, however, the mammogram showed no clip (Fig 3). By using the hematoma and residual calcifications as landmarks, a localizing needle was placed under ultrasound guidance (Fig 4, 5). At surgery, the lumpectomy specimen radiograph confirmed the presence of the hookwire (Fig 6). Histological analysis of the surgically excised tissue revealed infiltrating ductal carcinoma with free margins.

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  • Markus Holzhauer 2014-09-13 20:26:24

    this can happen - happened to me in 14 years doing this probably 1-2 times - after stereo but actually more frequently doing MRI guided biopsies where it is more difficult to determine in the first place if the clip was ever deployed ...maybe every year 1-2 times (doing MRI guided biopsy every week)


  • Tony 2014-09-13 19:09:00

    How do you explain the wire was not seen on mammogram but then later on again?