Women's Imaging: Needle Localization Procedures

Needle Localization Procedures

If a biopsy yields a diagnosis of cancer or precancerous (“high-risk”) lesion, surgery is usually then recommended to totally remove the area of abnormality. If the abnormality is not palpable (cannot be felt on physical exam) it is often necessary to perform a needle localization procedure. Needle localization may also be performed if ultrasound-guided, stereotactic, or MRI-guided biopsies have been unsuccessful at obtaining a diagnosis or are technically unable to be performed.

The goal of this procedure is to place a thin wire into the breast, directing it to the exact site of abnormality. The surgeon is then able to follow the wire into the breast and remove only the tissue containing the area of concern. On the day of surgery, before going to the operating room, the radiologist performs the needle localization procedure in the Women’s Imaging suite. In some cases, the needle localization may be performed by the surgeon in the operating room.

Needle localizations may be performed using mammographic, ultrasound or MRI guidance and this decision depends on your particular case and is determined by consultation of the radiologist and surgeon together.

Mammography-Guided Needle Localizations

This procedure is always performed in the Women’s Imaging Center. In some cases preliminary mammography images may be required to define the location of the abnormality being targeted for surgical removal. The radiologist will explain the procedure in detail and answers any questions you may have.

The patient is typically seated during this procedure and the breast is held in compression in the mammography machine. The compression paddle used for localization has an open area in the center, which allows passage of the needle. Mammogram images are obtained to visualize the area of concern and a grid is used to calculate the precise location of the abnormality.

The skin is cleansed with an antiseptic solution and a small amount of local anesthetic is given. A localizing needle is then placed in the breast and images are obtained to document accurate positioning of this needle. A small amount of temporary blue dye is injected into the breast tissue (this aids the surgeon in visualizing the area during the operation). A very thin wire is then placed through the needle and the needle is removed.

Final mammogram images are taken to document wire position and these images are sent with the patient to the operating room for your surgeon. The wire causes no pain and stays in place until surgery is performed later the same day.

Ultrasound-Guided Needle Localizations

This procedure may be performed by the radiologist in the Women’s Imaging Center or by a surgeon in the operating room, depending on the case. The radiologist performing the procedure explains the procedure in detail and answers any questions the patient may have.

During this procedure, the patient lies on her back on the ultrasound exam table. Ultrasound is used to locate the area of abnormality in the breast. The skin is cleansed with an antiseptic solution. Local anesthetic is injected into the skin and breast tissue to numb the area.

Using ultrasound guidance, the radiologist then places a localizing wire into the breast, directing it to the area of abnormality. A small amount of temporary blue dye is injected into the breast tissue (this aids the surgeon in visualizing the area during the operation). A very thin wire is then placed through the needle and the needle is removed.

Mammography images are then obtained to document positioning of the needle and both the ultrasound and mammogram images are sent with the patient to the operating room for the surgeon. The wire causes no pain and stays in place until surgery is performed later the same day.

MRI-Guided Needle Localizations

This procedure is always performed by a radiologist in the MRI suite. The radiologist performing the procedure explains the procedure in detail and answers any questions the patient may have. This is performed to guide a surgeon to an area of abnormality which is visible only on MR imaging, so that the area can be removed surgically.

For this procedure the patient lies face down on the MR exam table with her breasts suspended below the table in a “breast coil,” which helps to hold the breast still and is part of the imaging apparatus.

Preliminary MR imaging is performed after the patient receives an IV injection of gadolinium (contrast agent) and the radiologist reviews the images to locate and target the area of concern. A computer system calculates the exact location of the abnormality in three-dimensional space.

The skin is cleansed with an antiseptic solution and local anesthetic is injected into the skin and breast tissue. A localizing needle is placed into the breast, directed toward the area of abnormality.

MR images are obtained to document that the needle is in good position. A small amount of temporary blue dye is injected into the breast tissue (this aids the surgeon in visualizing the area during the operation). A very thin wire is then placed through the needle and the needle is removed. The wire causes no pain and stays in place until surgery is performed later the same day.

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