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  Indian J Med Microbiol
 

Figure 1: A 56-year-old female with biopsy-proven metastatic right axillary lymphadenopathy which became sonographically occult after neoadjuvant chemotherapy. Its far superior and posterior location, approximately 18 cm from the nipple, made localization by digital mammographic techniques difficult, so seed localization was performed under computed tomography guidance. (a) Preprocedural axial computed tomography identifies the targeted clip (arrow). (b) Repeat computed tomography with overlying opaque fiduciary markers (arrow) in place to help guide needle placement along the correct trajectory toward the clip. (c) An 18-gauge coaxial preloaded seed needle system (Best® Medical International, Springfield, VA, USA) (arrow) is advanced toward the clip for localization. It is slightly posterior to the target. (d) Needle is redirected towards the clip and is now seen immediately superficial to the clip (arrow). A I-125 radioactive seed was subsequently deployed. (e) Coronal image demonstrates the seed (arrow) to be immediately inferior to the clip (arrowhead), abutting the targeted lymph node. (f) Specimen radiograph from lumpectomy specimen demonstrates a faint outline of a lymph node with a targeted clip (arrowhead) and seed (arrow) within the excised tissue.

Figure 1: A 56-year-old female with biopsy-proven metastatic right axillary lymphadenopathy which became sonographically occult after neoadjuvant chemotherapy. Its far superior and posterior location, approximately 18 cm from the nipple, made localization by digital mammographic techniques difficult, so seed localization was performed under computed tomography guidance. (a) Preprocedural axial computed tomography identifies the targeted clip (arrow). (b) Repeat computed tomography with overlying opaque fiduciary markers (arrow) in place to help guide needle placement along the correct trajectory toward the clip. (c) An 18-gauge coaxial preloaded seed needle system (Best<sup>®</sup> Medical International, Springfield, VA, USA) (arrow) is advanced toward the clip for localization. It is slightly posterior to the target. (d) Needle is redirected towards the clip and is now seen immediately superficial to the clip (arrow). A I-125 radioactive seed was subsequently deployed. (e) Coronal image demonstrates the seed (arrow) to be immediately inferior to the clip (arrowhead), abutting the targeted lymph node. (f) Specimen radiograph from lumpectomy specimen demonstrates a faint outline of a lymph node with a targeted clip (arrowhead) and seed (arrow) within the excised tissue.