This document discusses using ultrasound guidance for breast procedures like cyst aspiration and biopsy. It describes how cyst aspiration is performed by inserting a needle under ultrasound guidance to drain fluid from cysts. It also outlines how to perform core biopsies on superficial and deep breast lesions using ultrasound to guide placement of the biopsy needle. Ultrasound is noted as an accurate and reliable method for guiding breast biopsies and cyst aspirations.

1. Presented by Syed Muhammad Yousaf Farooq
INTERVENTIONAL ULTRASOUND IN
BREAST

2.  Aspiration
 Biopsy
 Cysts aspiration

3.  Cysts aspiration:
 Cysts are very common.
 Usually be diagnosed accurately with
ultrasound.
 In most women, they do not usually require
any intervention or follow-up.

4. The patient lie on her back or slightly turned to one side
with the arm placed comfortably under the head.
The skin is cleaned , numbed with topical anesthesia. Using
ultrasound guidance, a small needle is advanced into the
cyst and suction is applied to draw the fluid out, causing
the lump to collapse.

6. THE LUMP (ARROW)
IN THIS PATIENT’S
RIGHT BREAST WAS
THOUGHT TO BE A
CYST, BUT SOME
FEATURES ARE NOT
CHARACTERISTIC
AND ASPIRATION
WAS NECESSARY.

7. Using ultrasound guidance,
a fine needle (white
line) is placed so that its tip
(double arrow) is in the
center of the lump (single
arrow). Aspiration is applied
by using a syringe attached
to the needle. If this is a
cyst, fluid is drawn into the
syringe as the lesion
collapses.

8. After the aspiration, the
needle (white line) and its
tip (double arrow) are
seen, but the lump is
gone.

9. PROBE ORIENTATION
Reference
marker corresponds
to left side of screen
(see
Screen Orientation Prob
e
Skin
Superficial “lesion”
to biopsy
Deep “lesion”
to biopsy

10. ROCK AND/OR SLIDE THE PROBE TO LINE UP
THE LESION
TO A “REACHABLE” POSITION
Deep lesion
needs to be lined
up toward the
edge of the beam
Superficial lesion
can be toward the
edge
or in the center
of the beam

11. ANGLE TO USE FOR A SUPERFICIAL
LESION: AIM NEEDLE MORE
PERPENDICULAR TO BEAM

12. SUPERFICIAL LESION CORE BIOPSY

13. SUPERFICIAL LESION CORE BIOPSY

14. PERCUTANEOUS NEEDLE BIOPSY OF THE BREAST
PROVIDES RELIABLE DIAGNOSIS OF BOTH BENIGN
AND MALIGNANT DISEASE AND IS A PROVEN
ALTERNATIVE TO OPEN SURGICAL BIOPSY

15. ULTRASOUND GUIDANCE IS AN ACCURATE AND
RELIABLE BIOPSY GUIDANCE TECHNIQUE AND IS
THE METHOD OF CHOICE AND SUITABLE FOR ALL
BREAST LESIONS VISIBLE ON ULTRASOUND

16. methods for theCNB & FNAB are effective
diagnosis of most breast
lesions
Although CNB has higher sensitivity & positive
predictive value for abnormalities like micro-
calcifications & distortions of architecture.

17. Focal mass or other lesion of unknown nature
– palpable or non-palpable
Architectural distortion
Micro-calcifications
Cyst aspiration

18. The use of ultrasound in needle guidance
Ultrasound is ideal for needle guidance.
1. It is real time – the needle can be visualized as it
moves through the tissues;
2. 2. The probe is hand held – the location of the
needle can be checked frequently in relation to
anatomical landmarks and the target lesion;
3. 3. Ultrasound is strongly reflected from metallic
objects – the needle is easily identifiable.

19. PROCEDURE:
The long axis of the needle, should be visible along
the long axis of the transducer.
Occasionally, during an FNA biopsy or cyst
aspiration, the transducer can be rotated 90
degrees to visualize the echogenic dot of
the needle within the lesion.

22. THANK YOU