Invasive Procedures Flashcards
Pneumothorax is associated with which bx type?
Core needle bx
Pneumocystogram
mammo image taken after doctor injects air into a cyst cavity, post aspiration
Indications for bx after aspiration: (4)
- thickened wall, difficult needle penetration
- abnormal tissue remains within cyst after fluid drained
- immediate recurrence of cyst
- bloody aspirate
Least traumatic bx procedure:
fine needle aspiration bx (FNAB) - cytology analysis
Core BX Device
14-18 g
During a bx, when is the needle best seen?
when beam is perpendicular to long axis of needle
Which procedure is done to avoid lumpectomy?
Core Needle Bx
Directional Vacuum Assisted Core BX (DVAB)
CNB performed with special needle and suction (ie Mammotome)
Mammotome:
can completely remove small tumors with rotating cutting instrument with 11g needle that removes tissue and vacuums it out for histology
Advanced Breast Biopsy Instrument (ABBI)
- stereotactic bx
- mammo and computer guid device
- large core bx(2 cm)
- prone position
- local anestesia
Surgical BX
Gold-Standard bx method
Incisional bx
removes section of tumor
Excisional bx
removes entire tumor and surrounding tissue
What localization is used for non-palpable lesions?
pre-opperative needle/dye localization
Axillary Lymph Node Dissection ( ALND)
removal of lymph nodes in the axilla for eval of mets from breast primary
Most common complication of ALND
lymphedema
Sentinel Lymph Node Dissection (SLND)
SNL removed or biopsied
Mammographic appearance of hematoma
- varies with age of hematoma
- may see mild increased density or distinct opaque mass or mass of varied density and retracted appearance
Sonographic appearance of hematoma
- round or oval
- wall thickening common
- fluid/debris levels common
- posterior enhancement varies with echogenicity of internal debris
Sonographic appearance of seroma
- irregular, as the fluid fills the surgical cavity
- debris and septations
- posterior enhancement varies
Lymphocele
collection of lymphatic fluid, usually related to surgery or interventional procedures
Irradiated breast tissue changes (6)
- skin thickening
- architectural distortion
- increased echogenicity of subcutaneous fat
- highly echogenic parenchyma
- fat necrosis
- edema
Fat necrosis
-uncommon inflammatory and ischemic process related to breast trauma…fat may turn into fibrous mass or oil cyst
Oil cyst on mammo:
round/oval radiolucent mass; varied fat/water density within cyst, eggshell calcification (radiodense capsule)
Mammo appearance of scarring
size and density decreases in time
Surgical Intervention (4)
- Lumpectomy
- Simple Mastectomy
- Radical Mastectomy
- Modified Radical Mastectomy**** most common
TRAM Flap Procedure
Transverse Rectus Abdominis Myocutaneous Flap…reconstructive surgery post-mastectomy
Systemic Therapy
Chemotherapy or hormone therapy
Neoadjuvant Chemotherapy
medications given before surgery to reduce size of tumor
Whole breast radiation therapy
4-6 weeks following lumpectomy
Brachytherapy
type of accelerated partial breast irradiation (APBI) or breast conservation therapy…treatment time is 5-7 days
