 Now next investigation is the tissue marker placement or clip placement. So what we place there is the ultra clip here, this is the ribbon shape which is easily available and this clip is inserted within this pen like needle. So this is inbuilt inside this needle tip and there is a push button. So once you identify the mask, you have to introduce the needle in the center of the mask and once you are in the correct position, you just press this push button and the clip inside, this is the ultra clip which is inside, it will get detached from the needle tip and it will remain there. Once you see that it has been detached, you can withdraw this needle and what remains, this is the clip inside. This is very useful patient who are going for the new adjuvant chemotherapy. Now diagnosed cases of breast cancer, many patients, they want to go for precise treatment like breast congestive surgery or minimal surgery and the oncologist, they want to place the clip because they want to start the patient on new adjuvant chemotherapy. After giving the new adjuvant chemotherapy, many patients, they are having good response that tumor may completely resolve what you will see at the end of the new adjuvant chemotherapy when the clip remains and the entire mask gets completely resolved. So in that case, just before the surgery, because they want to excise the tumor bed, they will ask you to mark the clip where it is and based on that, surgeon will take 2 cm of margin and they will do the breast congestive surgery. So nowadays, it is very important that you should know how to put the clip, where to put the clip so that oncologists, they don't have to send the case anywhere else and the patient gets the more precise surgery. Another procedure which can be done in adjuvant guidance is the hook wire localization. This is again, there is a needle like cannula. Inside this cannula, this is the hook wire which is inserted inside. It comes in a set. So you introduce this cannula at the center of the mask or just at the outer edge of the mask. Once you are at the correct site, what you do, this is the hook wire which remains inside this cannula. You push a little bit of this hook so that hook gets detached, it opens up and this j-light, it goes beyond the mask at the outer edge like this and this guide wire you leave inside and just withdraw this outer cannula. So this is like sheath like cannula, it comes out and what remains after placing this hook wire, this is the only wire remains and the wire part of the wire will be hanging outside. You can stick this to the skin so that it doesn't get displaced. So along the wire surgeon goes and they do the very small surgery so it will hardly cause any dysmarkism to the breast. So it is very important nowadays to know all these procedures because everybody is for personalized and precise treatment. After doing the surgery, now the surgeon wants to confirm whether the entire tumor has come out or not. So they will send for the sample mammography or sample ultrasound. You can see here after doing the surgery the mask and the wire completely has come out so there is nothing remaining inside. So this precise surgery can be done only if you know how to place the hook wire. Now next, which is the last one and this is the most recent entry to the breast intervention. This is the vacuum assisted breast biopsy or where vacuum assisted breast lump excision. This is diagnostic as well as therapeutic investigation where you can provide to the pathologist more amount of tissue for the diagnosis and you can have more diagnostic, better diagnostic yield. So it is again a minimally invasive technique which is more efficient than the core needle biopsy but less invasive than the open surgical biopsy. It can be done under mammography as Shilpa has already shown you that 2D or 3D guided vacuum assisted breast biopsy. It can be done in ultrasound guidance or MR guidance. Now I'm going to talk about ultrasound guided vacuum assisted breast biopsy. So this is the set, the difference between the core biopsy and the vacuum assisted breast biopsy is the breast biopsy needle size is larger than the core biopsy. It comes into like 10 gauge, 11 gauge and 7 gauge. If you're only using for the diagnostic purpose means you want small amount of tissue you can use 10 gauge or 11 gauge but if you're using for the therapeutic purpose you can use a thicker needle like 7 gauge. So the difference in placement of the needle tip is that in core biopsy you keep in the center like you keep here at the edge so that you can go you can shoot through the center of the mass but in vacuum assisted breast biopsy you keep the needle trough just under the mass or posterior to the mass. So when you start sampling this is the needle, this is the trough and this has got a blade here. So once you start sampling this blade keeps cutting and at the same time under vacuum this mass keeps falling under gravity to the trough. So cutting and vacuum collection happening simultaneously like you can see cutting and then simultaneously mass also is falling into the trough and it gets further aspirated under vacuum to the vacuum chamber.