Breast Procedures Ultrasound Only Edited

Breast Procedures and
Pathology Concordance
Dana Haddad, MD, PhD

Department of Breast Imaging
Mediclinic City Hospital
BREAST CANCER AWARENESS MONTH

Overview
• Understand the different image-guided modalities for breast biopsies
• Understand the different devices and equipment required
• Develop a methodologic approach to planning and performing biopsies
• Learn some techniques to minimize pain and bleeding
• Understand radiologic-pathologic concordance, and how to manage

different scenarios

Outline
• How to choose which biopsy to perform
• Biopsy tray
• Ultrasound biopsy
– Devices and clips
– Core biopsy
– Fine-needle biopsy and aspiration
– Post procedure mammogram
– Tips on local anesthetic and minimizing bleeding
• Briefly touch on
– Stereotactic
– Tomosynthesis
– MRI
– Pre-operative imaging guided localization
• Pathology concordance
• Questions

Selecting the modality to guide biopsy:
How was the lesion found?
Mammogram Ultrasound MRI
Evaluate with US
Can you find
the lesion on Yes US correlate
US? likely?
Yes
No Lesion
found? No No
Yes
Stereotactic US-guided MRI-guided

biopsy biopsy biopsy
Why is ultrasound
preferred
• Most reliable due to real-time visualization
• Allows access to all areas of breast
• Fast
• Most comfortable for the patient
• Arguably less bleeding risk as can more easily avoid vessels etc
• No radiation

Biopsy Tray

Chlorhexidine: For Pathology
skin specimen cup
Gauze pads can be Sterile saline: can

used for: be used to assist in
- holding pressure removing the
to control specimen from the
bleeding biopsy device
- wiping away
excess Blue needle:
ultrasound gel 25 gauge (g)
- maintaining needle with a 6 cc
sterility when syringe for
touching administering
nonsterile objects superficial
anesthesia
Gray needle:
Sterile probe 22 g needle with a
cover, drape 6 cc syringe for
and ultrasound deeper anesthesia
gel (*the lower the
gauge number, the
Scalpel: for making skin incision larger the needle)
Ultrasound-guided biopsy

Fine needle aspiration or
biopsy
• Aspiration
– Cyst
– Abscess
• Masses
– Usually lymph node, rare to do on solid mass

Core biopsy devices

US-Guided Core Biopsy
Trigger (A) – used to deploy

the needle when it is in optimal
14 Gauge Achieve Spring-loaded Biopsy Device position. The Achieve has a 2 cm
“throw” (distance the needle travels
once deployed) – therefore, make
sure there is enough room beyond
the target to avoid injury to nearby
structures (e.g. pectoralis muscle).
Trigger (D) – used to deploy the
needle without acquiring the
sample (“delay” mode).
Trough – where Cocking mechanism

the biopsy tissue is - One pull will expose the trough.
contained - Two pulls will pull the trough
- Trough can be and needle back for biopsy with a
visualized on throw.
ultrasound when - This device allows for a biopsy
without a throw; useful in 1% lidocaine is used for superficial
performing a
situations where the mass is anesthesia. 1% lidocaine containing
biopsy without a
epinephrine can be used for deeper
throw to allow for close to the chest wall, a blood
anesthesia to decrease bleeding via
careful
BREASTtargeting. vessel
CANCER AWARENESS MONTH or breast implant.
vasoconstriction.
Basics
• Positioning and how you hold the probe is crucial to a successful

biopsy
• The key that most people don’t tell you is that you hold the probe
parallel to the floor, not to the biopsy target, as this is the only
variable that remains stable
• This allows you to control your image, and maximize the sound
arrays from the probe. The sound waves are strongest in the center
of the probe.
• The deeper the lesion, the further away your skin nick should be
from the probe. Needle should as much as possible be parallel to
chest wall.

Basics
• US-guided biopsy with Bard 14 or 12

gauge core biopsy device
• - Patient positioned with the mass well seen and both patient and
radiologist comfortable
• - Sterile technique observed with sterile probe cover, gloves,
ultrasound gel and drape
• - Needle parallel to the transducer and entire length of the needle
visualized
• - Both hands are stabilized against the patient’s body for stable
controlled motions
• - Biopsy needle is advanced while course of the needle visualized
with ultrasound

Core biopsy
Step by step approach
• Need at least one assistant to take pictures if possible, so you can stay sterile
• Biopsy tray, biopsy device, and clip ready
• Clean the skin

• Place sterile cover if available
• Place sterile probe cover if available
• Sterile
• Locate the lesion and take a scout image
• Hold the probe parallel to the floor, and find the best positioning for the patient
– Check vascularity and avoid vessels if possible
• Inject local anesthetic – skin wheel and deeper, we do not use epinephrine anymore except for
stereotactic and MRI-guided biopsy
• Skin nick with scalpel
• Holding needle parallel to the probe, insert biopsy device
– Can use guide
– Can go in with trough open or closed
– Take at least 3 samples, more if samples not adequate
– GENTLY place samples in container with formalin, make sure it is completely covered to
avoid ischemic time, avoid crushing injury to sample
• Take pre and post fire pictures to document you are in the lesion
• Place clip and confirm clip placement with picture

• Remember if complex systic and solid mass, need to sample the
solid com[onent

US-guided biopsy with

Bard 14 gauge core
biopsy device
- Patient positioned with the
mass well seen and both
patient and radiologist
comfortable
- Sterile technique observed
with sterile probe cover,
gloves, ultrasound gel and
drape
- Needle parallel to the
transducer and entire length
of the needle visualized
- Both hands are stabilized
against the patient’s body
for stable controlled motions
- Biopsy needle is advanced
while course of the needle
visualized with ultrasound
Steps:
1. Begin with steps 1-4 from US-guided cyst aspiration. Use 1%
lidocaine to make a skin wheal at the entry point. Use US guidance
for deeper local anesthesia with 1% lidocaine with epinephrine.
2. Make a ~ 5 mm dermatotomy using the scalpel at the optimal entry
point.
3. An introducer sheath may be used to allow for multiple entries
through the same tract. This is done, with US guidance, by inserting
the sheath with the inner stylet into the breast towards the target of
interest. When the needle is immediately abutting the target, but not
through the target, the inner stylet is removed and the sheath
remains in place. Note that use of an introducer can be associated
with the introduction of air artifacts.
4. Using US-guidance, direct the biopsy device towards the target. A
steep angle may be used initially and then flatten out so that the
needle is parallel to the chest wall.
Steps (cont.):
5. Bring the needle tip to the edge of the mass. Allow room for a 2 cm
throw and deploy the device.
6. Remove the biopsy device. If no introducer is used, the incision can
be covered with gauze and pressure applied.
7. Cock the biopsy device once to expose the sample. Place the
sample in the specimen cup (which is not sterile). Make sure to
keep the biopsy device sterile when removing the specimen.
8. It is standard to take a total of 5 specimens, although as few as 3
can be taken at the radiologist’s discretion, depending on the
specimen quality.
9. Place a tissue marker at the biopsy site. The shape of the marker
should be unique if the patient already has markers in that breast.
10.Hold pressure for ~5 minutes after the procedure. Place steri-strips
and bandage over the incision.
11.Take a mammogram to confirm tissue marker placement with CC
andCANCER
BREAST 90 degree lateral views.
AWARENESS MONTH
Fine needle aspiration

US-Guided Fine Needle Aspiration (FNA)
Indications: Steps for Cyst Aspiration:
1. Cyst aspiration 1. Begin with the standard tray set-up.
- For treatment of symptomatic 2. Choose the area by ultrasound and make a preliminary
skin mark using an indentation with the needle cap or a
breast cysts.
marking pen.
- For diagnosis of masses on
3. Perform a “time out” confirming the patient’s name, date
ultrasound presumed to be of birth, planned procedure and procedure location. The
complicated cysts. site for the procedure should be marked and initialed.
2. Lymph node biopsy 4. Cleanse the area of interest for sterile technique.
- For diagnosis of suspicious ChloraPrep is used at our institution. While the skin is
lymphadenopathy. drying, use this time to draw up 1% lidocaine and place
3. Mass biopsy the sterile cover on the ultrasound probe. Place a sterile
drape on the patient.
- For biopsy of difficult to access
5. Using a 25 gauge needle inject 1% lidocaine to make a
masses (e.g. masses adjacent skin wheal at the entry point. Then inject deeper
to implants or large blood numbing towards the target.
vessels). 6. For a simple cyst aspiration – a 22 gauge needle (shown
to the left in gray-with safety lock) is generally sufficient.
If the cyst is complicated with thick debris, a larger
gauge (18 gauge – pink needle to the left) may be
necessary.
7. Using US-guidance, direct the needle towards the cyst
and aspirate with the syringe once inside the target.
8. Place a bandaid at entry point. If fluid is bloody, it can be
BREAST CANCER AWARENESS MONTH sent for cytologic analysis. In this case, the location of
the cyst can be marked with a metallic tissue marker.
US-Guided Lymph Node FNA
Left Axilla
Clinical Case: Patient with history of breast cancer, sent to
breast imaging for new suspicious left axillary adenopathy
identified with a CT scan.
1. Diagnostic left axillary ultrasound performed to locate the
best target for biopsy. Choose the most suspicious lymph
node (e.g. thickest cortex / loss of fatty hilum) and favor a
more superficial lymph node (easier to access).
2. Begin as if performing a cyst aspiration.
3. Using a 23 gauge syringe, enter the lymph node of
interest and pass the needle back and forth 10 or more
times within the target. Repeat this step 3 times. Slides can
be made from each aspirate and remaining sample can be
placed in CytoLyt for cytologic analysis
4. Hold pressure and place bandaid over the entry point.
1. 2.
1 2
Target in sight: Needle advanced up to the mass,
Left breast, 9:00, 4 cm FN, ARAD parallel to the chest wall, ready to deploy.
3. 4.
3 4
Post-deployment orthogonal view confirming
Post-deployment image needle placement through the center of the
showing adequate sampling mass, which can be done if there is concern
through the mass with needle tip for peripheral sampling.
Post-biopsy Mammogram

Post Biopsy Mammogram
Following US-guided, MRI –guided
and stereotactic core biopsy, two
views with 90 degree lateral and
craniocaudal images of the breast
are routinely obtained to confirm
accurate clip placement and
correlate an ultrasound or MRI
finding with a possible
mammographic finding.
Clip displacement can sometimes

occur and is important to note on the
post-biopsy exam.
The shape of the clip used to mark

the biopsy site should be reported as
patients will sometimes have more
than one clip. If possible, always use
Left Left a different shape for each biopsy
LM
Post US-guided biopsy with
CC site. Standardized terminology
Craniocaudal view should be used to describe the clip
clip placement left 90 degree demonstrating central clip
lateral view demonstrating placement within the shape and can be found on the
appropriate position of the clip. targeted mass. packaging of the clip deployment
device.
Tips on local anesthesia and minimizing bleeding

Local

• Use the smallest gauge needle you can – normally 25 gauge

Stereotactic Biopsy

Stereotactic Biopsy
- Most frequently performed on
calcifications
- Also used for architectural
distortion, sonographically
occult masses, focal
asymmetries or asymmetries
- Can target a finding only
seen on 1 view
- Performed under vacuum
assistance to ensure
Opening in the center of the Operator adequate sampling volume
table through which the work area
patient’s breast is placed.
The patient lays in the prone
position. She can have her
head on either side of the Stage
table (depending on the
approach).
BREAST CANCER AWARENESS MONTH for
Stereotactic Biopsy
Steps: 4. For both stereo images, select the target as
1. Decide on an approach, such as the area of interest on the computer screen,
craniocaudal or lateromedial, based on identifying its position in the x and y axes.
the shortest distance to the target. Note, the finding can also be localized with a
2. Position the patient and take scout images combination of one stereo image and the
until the target is in the center of the field scout image.
of view. Reposition if necessary to avoid 5. The computer calculates the z axis finding
blood vessels. location. For the given needle, check the
3. Take a stereo pair of two images at +15° safety equation of breast compression
degrees and -15° relative to the scout. thickness minus target z coordinate to confirm
the needle can be safely advanced.
6. Transmit the target coordinates to the biopsy
table.
Initial scout image with calcifications

near central field of view Pre-deployment stereo pair images taken at +15° and -15°
Stereotactic Biopsy
Steps (cont.):
7. Prep the patient using sterile technique.
8. Place biopsy device needle on stage and set z-zero axis
reference point. This provides a reference point of the
needle’s z position at the skin surface, so that it can then be
advanced to the proper depth.
9. Position the stage at the target x and y axis coordinates.
This allows the operator to determine where anesthesia
should be administered.
10. Inject superficial anesthesia with lidocaine and deeper
anesthesia with lidocaine and epinephrine.
11. Make a dermatomy at the entry point. Insert biopsy needle
to depth that corresponds with the pre-deployment position.
Post procedure specimen radiograph 12. Take a stereo pair of images to confirm needle positioning.
with calcifications in multiple Adjust if needed.
samples. 13. Deploy biopsy device. Take multiple samples, typically 6,
rotating the needle between each sample.
14. Lavage the biopsy cavity.
15. Collect the samples. If biopsying calcifications, leave the
needle in place until the specimen is x-rayed and
calcifications are confirmed to be in sample.
16. Remove the biopsy needle and place the biopsy marker clip.
Image post biopsy clip placement 17. Compress biopsy site for 5 minutes and then bandage.
(note: no significant residual calcifications)
BREAST CANCER AWARENESS MONTH 18. Obtain a post-procedural mammogram.
Tomosynthesis-guided Biopsy

3D Tomosynthesis-Guided Biopsy
Purpose:
Used for lesions not seen on
2D mammography or US.
BREAST CANCER AWARENESS MONTH Courtesy Hologic, Inc.
3D Tomosynthesis-Guided Biopsy
Steps: 5. Proceed with general biopsy steps
(prep and sterilize), advance the
1. Position the breast in compression and obtain an needle, take the samples, and
initial scout 3D tomosynthesis. place the clip.
2. Identify the slice that shows the lesion the best. 6. Obtain a post biopsy tomo to
3. Create the target by clicking on the target button. ensure clip is in the correct place.
4. Software selects the coordinates and provides a 7. Hold pressure for 5 minutes and
picture of the biopsy plan. dress the wound.

Courtesy Hologic, Inc.
MRI-guided Biopsy

MRI-Guided Biopsy
MRI Guided Biopsy Tray
Assembled trocar with sheath and
Set-Up
Right: Sample
1 attached syringe with lidocaine flush
vacuum 2
assisted MRI-
guided biopsy
device
3
Sterile Biopsy Guide
4 5
Grid
1 – Scalpel for skin incision Left: Specimen container

2 – Introducer sheath with from vacuum assisted
flush and black stopper MRI guided biopsy
(yellow box)
– Trocar
3 BREAST CANCER AWARENESS MONTH
MRI-Guided Biopsy
Image 2:
Post-contrast image
identifies the target
mass. A cursor is
placed on the mass to
determine its
coordinates in 3
dimensions for
localization. 3
1
Image 3:
Image 1: Localizing obturator (with high
Patient positioned in signal gadolinium segment) was
compression with placed into the introducer sheath
localizing grid at the skin. and imaging performed. The
Fiducial marker (circled in gadolinium segment is well
yellow) placed in a positioned, superimposed on the
reference grid box to target mass.
assist with x-y After this step, vacuum-assisted
localization. This image is 2
BREAST CANCER AWARENESS MONTH biopsy is performed at this location.
also used to localize the
Localizations

Needle Localization
System
Accura brand Kopans-type wire/needle localization system
1 2 3
1 – Single and double

marked lines, which
correlate to wire location When the first (single) mark on the
inside needle wire is at the needle hub, the wire
2 – Thick/reinforced tip is at the needle tip.
segment of wire
3 – Hook of the wire –
When the second (double) mark on
helps keep the wire in
BREAST CANCER AWARENESS MONTH the wire is at the needle hub, the
place
Image 1: Image 3:
- Biopsy proven - Perpendicular lateral
malignancy target view of the needle
in the posterior demonstrating
central breast for localization in the z
needle dimension with the
localization needle tip adjacent to the
- Mass located clip and at the mass
inside - Note location of the
alphanumeric grid needle tip to ensure
(allowing x-y accurate placement of
1 localization)
3 the localization wire
Image 2: Image 4:
En face Final image

craniocaudal showing
view of needle in appropriate
position with hub position of the wire
over biopsy clip with the
and mass, thick/reinforced
confirming segment along the
localization in x-
y BREAST
dimensions 2
CANCER AWARENESS MONTH
targeted clip and
mass
4
Ultrasound Guided Needle Localization
 Begin with steps 1-5 from US-guided fine needle aspiration.
 Under ultrasound guidance a localizing needle is inserted through
the target mass.
 The needle tip should be approximately 1 cm beyond the mass.
 The needle is then exchanged for a localizing wire. The wire is then
advanced through the localizing needle under real-time ultrasound
imaging. Minor adjustments can be made to ensure the thick part of
the wire should be at the target mass.
 Following placement of the needle under ultrasound guidance, a
mammogram is taken to help guide the surgeon.
 Once surgically removed, the surgical specimen is x-rayed to
confirm removal of the target. If the target is only seen under
ultrasound, the specimen may be evaluated with ultrasound.
Ultrasound Guided Needle Localization
Right CC Right ML
Surgical specimen radiograph confirms removal
of the targeted mass and biopsy marker clip.
Image 1:
Localizing needle is
placed through mass.
Image 2:
The needle is exchanged
for a localizing wire.
Post-procedure mammogram confirms 2 satisfactory placement of the
localizing
BREAST CANCER wire
AWARENESS relative to the targeted mass and biopsy marker clip.
MONTH
Saviscout and
magseed, radioactive
seed localization

Rad-Path Concordance

Bottom line….
Differential
High risk
Cancer Not Cancer
lesion

Breast Pathology
Breast Disease
High risk Malignant

Benign
Excisional Biopsy Surgery/oncology
• Fibroadenoma • Papilloma • Invasive ductal

• PASH • Atypia carcinoma
• Nodular fibrosis • FEA • NOS, tubular,
• Cysts • ADH medullary,
• Sclerosing adenosis • ALH anaplastic
• Phylloides • Invasive lobular
• Radial scar/ Complex carcinoma
sclerosing lesion > • DCIS
1cm • Inflammatory BC
• LCIS • Less common
• Angiosarcoma

ROUTINE
LESION EXCISE F/U UPGRADE RATE REFERENCES
26%
ADH X 22/104 (21%) http://www.ncbi.nlm.nih.gov/pubmed/
12147855
unpublished MSKCC data, Open TBCRC
Flat epithelial atypia/CCWA X 10% Study
9% http://www.ncbi.nlm.nih.gov/pubmed/
Lobular neoplasia (LN) 21989373
http://www.ncbi.nlm.nih.gov/pubmed/
Classic LN on MG or US X (RISE) 2/72 (3%) 23132235

Classic LN on MR X (RISE) 2/81 (2.5%) unpublished MSKCC data/in submission
Variant LN (pleomorphic, necrosis, massive acinar
expansion) X 25% http://www.ncbi.nlm.nih.gov/pubmed/
22037287
Radial Scar 10.4% http://www.ncbi.nlm.nih.gov/pubmed/
1/48 (2%) MSK ?term=RADIAL+SCAR+and+cONLON
No atypia X 7.5%
Atypia X 26%
Incidental/completely excised by imaging or pathology X
Papilloma 1% (1/106) Open TBCRC Study
4/171 (2.3%), 4% all
No atypia X recent studies In press (CNCR-16-0097.R1)
wide range of
Atypia X upgrade
Benign vascular lesion
No atypia X 0/22 (0%) unpublished MSKCC data
Atypia X
Mucocele-like lesion 4/28 (14%) http://www.ncbi.nlm.nih.gov/pubmed/
No atypia X 0/10 (0%) 23534893

Atypia X 4/18 (22%)
Fibroepithelial lesions X http://www.ncbi.nlm.nih.gov/pubmed/
25162470

Recommendations
• Benign and concordant

• Benign and discordant
• Malignant and concordant
• High risk, surgical consultation

– Vacuum-assisted excision
– Diagnostic excision
– Can also follow in rare circumstances, eg LCIS classical features

Why discordant?
• Discordant means that imaging characteristics does not match pathology
• Human error with labelling

– Ensure correct sample
• Undersampling or not in lesion

– Heterogeneity within sample
– larger the lesion, more chance discordant, undersampling,
– Smaller the needle, high chance discordant
• Distortion during storage and fixation
• How specimen is cut
• Pathology interobserver variability

– Especially with borderline lesions
– Counting ducts or mitosis per field
– Small volume, crush injury

Reported factors

How do you now if
something is
concordant or
discordant
• Here is where your skill as a radiologist really come into play

Ultrasound BIRADS Masses 
Shape  Orientation  Margin 
Echo Pattern  Posterior Acoustic
Features
US BI-RADS Mass • Mass Shape –

Oval – Round – Irregular • Mass
Margin – Circumscribed – Not
Circumscribed • Indistinct •
Angular • Microlubulated •
Spiculated • Mass Orientation –
Parallel (wider-than-tall) – Not
Parallel (taller-thanwide)
• Circumscribed • Not Circumscribed –Indistinct –

Microlobulated –Angular –Spiculated 10% 45% 50% 60%
85%
How do you now if
something is
concordant or
discordant
• Ask yourselves these questions:

• Assess finding to determine level of concern (BI-RADS 4 or 5) •
Plan out best biopsy method • Radiology-Pathology concordance
important process • Recommendations for high risk lesions vary by
lesion and will change over time

Questions

Needle Gauges
• Which is correct?
a) 14 gauge needle with vacuum assistance has a lower undersampling rate than the
12 gauge without vacuum assistance
b) 12 gauge needle with vacuum assistance has a higher undersampling rate than
the 14 gauge without vacuum assistance
c) 14 gauge needle without vacuum assistance has a lower undersampling rate than
the 12 gauge without vacuum assistance

Question 4
You are targeting a posterior lesion for ultrasound guided core

biopsy. Which of the following techniques may be employed to
obtain an adequate sample without injuring the chest wall?
(Choose all that are correct.)
1. Take fewer samples.
2. Inject anesthetic posterior to the lesion and anterior to the
chest wall to act as a cushion.
3. Enter the skin at a greater distance from the lesion.
4. Position the device perpendicular to the chest wall.
Always make sure the needle is parallel to the chest

wall!
Question
• What is the best recommendation for this ultrasound mass, which

came back as a fibroadenoma?
a. Benign, discordant
b. Benign, concordant
c. High risk, surgical consultation

Question
• What is the best recommendation?
a. Benign, concordant
b. Benign, discordant
c. High risk, surgical consultation
d. Malignant, conordant


Breast Procedures Ultrasound Only Edited

Uploaded by

Copyright:

Available Formats

Breast Procedures Ultrasound Only Edited

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Breast Procedures Ultrasound Only Edited

Uploaded by

Copyright:

Available Formats

Breast Procedures and

Dana Haddad, MD, PhD

BREAST CANCER AWARENESS MONTH

• Understand the different image-guided modalities for breast biopsies

• Understand the different devices and equipment required

• Develop a methodologic approach to planning and performing biopsies

• Learn some techniques to minimize pain and bleeding

• Understand radiologic-pathologic concordance, and how to manage

BREAST CANCER AWARENESS MONTH

• How to choose which biopsy to perform

BREAST CANCER AWARENESS MONTH

Mammogram Ultrasound MRI

Stereotactic US-guided MRI-guided

• Most reliable due to real-time visualization

• Allows access to all areas of breast

• Most comfortable for the patient

BREAST CANCER AWARENESS MONTH

BREAST CANCER AWARENESS MONTH

Gauze pads can be Sterile saline: can

BREAST CANCER AWARENESS MONTH

BREAST CANCER AWARENESS MONTH

BREAST CANCER AWARENESS MONTH

Trigger (A) – used to deploy

Trough – where Cocking mechanism

• Positioning and how you hold the probe is crucial to a successful

BREAST CANCER AWARENESS MONTH

• US-guided biopsy with Bard 14 or 12

BREAST CANCER AWARENESS MONTH

• Clean the skin

BREAST CANCER AWARENESS MONTH

BREAST CANCER AWARENESS MONTH

US-guided biopsy with

BREAST CANCER AWARENESS MONTH

BREAST CANCER AWARENESS MONTH

Clip displacement can sometimes

The shape of the clip used to mark

BREAST CANCER AWARENESS MONTH

BREAST CANCER AWARENESS MONTH

BREAST CANCER AWARENESS MONTH

BREAST CANCER AWARENESS MONTH

Initial scout image with calcifications

BREAST CANCER AWARENESS MONTH

BREAST CANCER AWARENESS MONTH

BREAST CANCER AWARENESS MONTH

1 – Scalpel for skin incision Left: Specimen container

BREAST CANCER AWARENESS MONTH

1 – Single and double

En face Final image

BREAST CANCER AWARENESS MONTH

BREAST CANCER AWARENESS MONTH

BREAST CANCER AWARENESS MONTH

High risk Malignant

• Fibroadenoma • Papilloma • Invasive ductal

BREAST CANCER AWARENESS MONTH

BREAST CANCER AWARENESS MONTH

• Benign and concordant

• Malignant and concordant

• High risk, surgical consultation

BREAST CANCER AWARENESS MONTH