Case 34 Answer 4

A and C at minimum.

Before performing core biopsy, one should always document images of the mass about to be biopsied, generally with at least two orthogonal views. This establishes images in your institution (often images done in the diagnostic work-up are performed at another location). It also documents that the mass being biopsied is indeed the mass recommended for biopsy. It also documents the appearance pre-biopsy, since it may change post-biopsy.

It is critical to obtain an image showing the needle in the mass. This documents that you have sampled the mass. I generally obtain a pre- and post-fire shot for each core sample. I obtain 3 good core samples so the pathologist has enough tissue to analyze.

It is not critical to obtain post-biopsy images, unless the appearance of the mass changes significantly OR a clip is placed and mammographic confirmation is desired OR there is a question as to whether or not the ultrasound mass is the same as the mammographic mass, this can be confirmed after the biopsy if the clip is placed.

 

The most likely pathology is

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