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  Indian J Med Microbiol
 

Figure 6: 52 year old female with biopsy proven left breast invasive ductal carcinoma, marked by a wing shaped clip. Postneoadjuvant therapy magnetic resonance imaging demonstrated an additional focus of enhancement 1.3 cm posterior to the index mass which was suspicious. Magnetic resonance imaging guided two-site wire localization of a known breast malignancy associated with a wing-shaped clip and of an adjacent suspicious focus was performed. (a) Noncontrast sequence at the time of Magnetic resonance imaging guided biopsy demonstrating susceptibility artifact from clip marking the site of biopsy proven malignancy (arrow). The suspicious focus of enhancement is seen posteriorly (arrowhead). A grid is present laterally as noted by flattening of the skin, but is not well visualized on this image. (b) Postcontrast image postplacement of the biopsy device in good position and obturator in place from a lateral approach. The suspicious focus of enhancement (arrow) is noted immediately medial to the tip of the obturator. (c) A 2nd biopsy device is positioned anteriorly (arrow) in the region of biopsy clip marking the site of malignancy. The biopsy clip is immediately inferior to the obturator tip. Arrowhead marks obturator placed at the suspicious focus of enhancement. (d) Postprocedure mammogram demonstrating the posterior wire in good position (arrowhead), immediately posterior to the region of enhancement noted on magnetic resonance imaging. Given that this focus is mammographically occult, postwire localization magnetic resonance imaging suggests that it should be near the distal thickened hook portion of the wire. The wing clip (arrow) marking the site of biopsy proven malignancy is approximately 1 cm inferior to the hook portion of the anterior wire. Ribbon clip in the inferior breast is from a prior benign biopsy.

Figure 6: 52 year old female with biopsy proven left breast invasive ductal carcinoma, marked by a wing shaped clip. Postneoadjuvant therapy magnetic resonance imaging demonstrated an additional focus of enhancement 1.3 cm posterior to the index mass which was suspicious. Magnetic resonance imaging guided two-site wire localization of a known breast malignancy associated with a wing-shaped clip and of an adjacent suspicious focus was performed. (a) Noncontrast sequence at the time of Magnetic resonance imaging guided biopsy demonstrating susceptibility artifact from clip marking the site of biopsy proven malignancy (arrow). The suspicious focus of enhancement is seen posteriorly (arrowhead). A grid is present laterally as noted by flattening of the skin, but is not well visualized on this image. (b) Postcontrast image postplacement of the biopsy device in good position and obturator in place from a lateral approach. The suspicious focus of enhancement (arrow) is noted immediately medial to the tip of the obturator. (c) A 2<sup>nd</sup> biopsy device is positioned anteriorly (arrow) in the region of biopsy clip marking the site of malignancy. The biopsy clip is immediately inferior to the obturator tip. Arrowhead marks obturator placed at the suspicious focus of enhancement. (d) Postprocedure mammogram demonstrating the posterior wire in good position (arrowhead), immediately posterior to the region of enhancement noted on magnetic resonance imaging. Given that this focus is mammographically occult, postwire localization magnetic resonance imaging suggests that it should be near the distal thickened hook portion of the wire. The wing clip (arrow) marking the site of biopsy proven malignancy is approximately 1 cm inferior to the hook portion of the anterior wire. Ribbon clip in the inferior breast is from a prior benign biopsy.