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  Indian J Med Microbiol
 

Figure 7: 70-year-old female with a history of right breast atypical lobular hyperplasia and multiple other benign biopsies. High risk screening magnetic resonance imaging, demonstrated a new suspicious linear nonmass enhancement which underwent MR biopsy and demonstrated ductal carcinoma in situ, marked by a bowtie-shaped clip. There was an additional enhancing mass seen on magnetic resonance imaging 1 cm posteriorly that in retrospect correlated with a mammographic focal asymmetry. The surgeon requested a single wire localization of both the clipped malignancy as well as the nearby focal asymmetry. (a) Initial magnetic resonance imaging demonstrates suspicious linear nonmass enhancement in the lower outer breast, middle dept. (b) Initial mediolateral scout image prior to tomosynthesis guided localization demonstrating a focal asymmetry (arrow) in the inferior breast. (c) Tomosynthesis image demonstrates the needle tip and targeted bow-tie clip (arrow) are in the same plane. (d) Needle is advanced past the clip towards the asymmetry on mammogram corresponding to the site on enhancement on prior magnetic resonance imaging. (e) Postlocalization tomosynthesis image shows a single Homer needle coursing just superior to the bowtie-shaped clip marking the site of biopsy-proven ductal carcinoma in situ with the distal tip of the needle just superior to the location of the focal asymmetry best corresponding to the enhancing mass. The concave portion of the Homer wire curves inferiorly and encompasses the focal asymmetry.

Figure 7: 70-year-old female with a history of right breast atypical lobular hyperplasia and multiple other benign biopsies. High risk screening magnetic resonance imaging, demonstrated a new suspicious linear nonmass enhancement which underwent MR biopsy and demonstrated ductal carcinoma <i>in situ</i>, marked by a bowtie-shaped clip. There was an additional enhancing mass seen on magnetic resonance imaging 1 cm posteriorly that in retrospect correlated with a mammographic focal asymmetry. The surgeon requested a single wire localization of both the clipped malignancy as well as the nearby focal asymmetry. (a) Initial magnetic resonance imaging demonstrates suspicious linear nonmass enhancement in the lower outer breast, middle dept. (b) Initial mediolateral scout image prior to tomosynthesis guided localization demonstrating a focal asymmetry (arrow) in the inferior breast. (c) Tomosynthesis image demonstrates the needle tip and targeted bow-tie clip (arrow) are in the same plane. (d) Needle is advanced past the clip towards the asymmetry on mammogram corresponding to the site on enhancement on prior magnetic resonance imaging. (e) Postlocalization tomosynthesis image shows a single Homer needle coursing just superior to the bowtie-shaped clip marking the site of biopsy-proven ductal carcinoma <i>in situ</i> with the distal tip of the needle just superior to the location of the focal asymmetry best corresponding to the enhancing mass. The concave portion of the Homer wire curves inferiorly and encompasses the focal asymmetry.