Basic Needle Insertion Techniques

  • Bruno D. Fornage


This chapter describes the basic techniques used to insert a needle or device percutaneously in the breast under ultrasound guidance. By far, the most common technique used is the freehand technique with in-plane insertion of the needle or device. However, the possibility of using a needle guide is addressed. Differences between the techniques for fine-needle aspiration, core-needle biopsy, and vacuum-assisted biopsy are discussed, as is the vertical or out-of-plane insertion technique. The optimal way of holding the transducer and the biopsy needle or other interventional device or probe is described. The necessity of training by practicing on phantoms is stressed. Techniques to prepare low-cost phantoms are illustrated.


Volume averaging artifact Freehand technique In-plane needle insertion technique Out-of-plane needle insertion technique Needle guides Training Phantoms 

Supplementary material

Video 5.1

Volume averaging artifact affecting the ultrasound-guided fine-needle aspiration of a tiny (3-mm) cyst using a 13–5-MHz transducer). Although the needle seems to have penetrated the cyst, the cyst cannot be aspirated. It is only at 26 seconds that the needle, after being slightly reoriented, pierces the cyst, which can then be aspirated. (MP4 19354 kb)

Video 5.2

Ultrasound-guided fine-needle aspiration using the in-plane needle insertion technique. The needle, which is aligned with the scan plane, appears brightly echogenic because the lesion is superficial and the angle of insertion is shallow. The tip is well identified as the bevel is facing upward. (See also Fig. 5.5). (MP4 5808 kb)

Video 5.3

Ultrasound-guided fine-needle aspiration of a subcutaneous 8-mm local recurrence from breast cancer in a breast containing an implant. Because the brightly echogenic needle is always well visualized, there is no risk of inadvertently piercing the implant. (See also Fig. 5.6). (MOV 12071 kb)

Video 5.4

Ultrasound-guided fine-needle aspiration of an indeterminate skin lesion in a 28-year-old woman recently diagnosed with a high-grade metaplastic carcinoma in the same breast. The needle has been inserted in the subcutaneous fat from a remote entry point and directed upward toward the skin lesion, which can be satisfactorily sampled. (See also Fig. 5.7). (MP4 9898 kb)

Video 5.5

Ultrasound-guided fine-needle aspiration of a deep infraclavicular lymph node. Because of the steep angle of the needle, the shaft is poorly seen. However, the bevel is clearly identified and its to-and-fro motion within the small metastatic node can be monitored. (See also Fig. 5.8). (MOV 1583 kb)

Video 5.6

Ultrasound-guided fine-needle aspiration of a small metastatic axillary node. The needle is inserted at a 50° angle, and the shaft is not well visualized. The tip is seen in the targeted node. Rotating the needle-syringe assembly enhances (and confirms) the visibility of the bevel. (MOV 2653 kb)

Video 5.7

A resident practicing ultrasound-guided fine-needle aspiration on a phantom. He watches the monitor but constantly checks the alignment between the needle and the scan plane by looking at the biopsy site. (MOV 8986 kb) (MP4 11345 kb)

Video 5.8

Ultrasound-guided fine-needle aspiration of a tiny (5-mm) internal mammary lymph node metastasis in the first right intercostal space using a lateral to medial approach. (The examination bed has been turned 90°, and the operator is working from behind the head of the patient.) The videoclip shows the fine needle progressing through the pectoralis major muscle at a shallow angle to reach the small metastasis, which is adjacent to the internal thoracic artery and vein. The sampling starts at 10 seconds, lasts 14 seconds, and is fully documented by the videoclip. (MOV 8986 kb)

Video 5.9

Preparation of small “cysts” to place in phantoms for training. A latex glove is filled with water and is held by an assistant while the fingertips are tied closed before being cut off. (MOV 4831 kb)


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Bruno D. Fornage
    • 1
  1. 1.The University of Texas MD Anderson Cancer CenterHoustonUSA

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