How to do needle localization
- First look at pre localization films to get a sense of which quadrant the lesion is
- usually the pt. has a biopsy clip in place and the target for the localization is the biopsy clip. Other times, the target will be suspicious calcifications for surgical excision
- Decide whether coming from medial or lateral part of the breast
- typically pt. will be imaged in the M-L tomographic view
- localize the clip on the ML image, locate image using the ABC 123 system.
- Give localization to technologist
- Start procedure
- clean skin with alcohol swab
- numb skin with lidocaine needle. numb in the following fashion, make skin wheal, then advance needle in, inject lido on the way out, keep doing till all the way through the breast to the other side. Make sure entire thickness of the breast from medial to lateral is numb.
- Then grab the needle, usually 5 cm Homer or Kopans needle
- insert needle straight down the crosshairs of the target. Ensure the hub shadow directly overlies the cross between the cross hairs. This ensures the needle is going exactly flush and perpendicular to the skin surface, going straight to the target. Go all the way to hub of the needle
- Then release pt's breast and go to CC mammo view
- Now can adjust the other plane of localization.
- If lesion is more proximal, pull needle back slightly. Avoid pulling too far back because cannot advance in a straight line any longer and will have to restart procedure
- If using Kopans needle, make sure to engage needle. Check the lines on the needle to see where the wire exits the needle
- Print localization films and mark them so surgeon is aware of distance from needle to target, if not obvious.
- Procedure complete