A plea for the biopsy marker: how, why and why not clipping after breast biopsy?

Abstract

In the last decade, percutaneous breast biopsies have become a standard for the management of breast diseases. Biopsy clips allow for precise lesion localization, thus minimizing the volume of breast to be resected at the time of surgery. With the development of many imaging techniques (including mammography, sonography, and breast magnetic resonance imaging), one of the challenges of the multidisciplinary became to synthesize all informations obtained from the various imaging procedures. The use of biopsy markers after percutaneous biopsy is one of the keys for optimal patient management, helping the radiologist to deal with multiple lesions, to insure correlation across different imaging modalities and to follow-up benign lesions, helping the oncologist by marking a tumor prior to neoadjuvant chemotherapy, helping the surgeon by facilitating preoperative needle localization, to precisely mark the margins of extensive disease and to guide intraoperative tumor resection, and helping the pathologist to insure the lesion of interest has been removed and to identify the region of interest in a mastectomy specimen. We believe biopsy clip markers should be deployed after all percutaneous interventions and present in this review the arguments to support this statement. Minimal indications for clip deployment will also be detailed.

A prospective comparative study to evaluate the displacement of four commercially available breast biopsy markers

“…Collagen (used in the MammoMARK™) has the added benefit of activating the coagulation cascade, which confers enhanced haemostasis. 2,4,17 One area of concern was that when the markers did displace in our study, the distance from the biopsy cavity was considerable -10 mm or more in 86% of the displaced cases. This is speculated to relate, at least in part, to the slippery surface of the gel-like polymeric component of some of the markers.…”

“…In the early to mid-1990s, the placement of a radiopaque metallic post-biopsy clip began gaining popularity in cases where the mammographic abnormality was determined to be no longer visible. 2 Since then, the use of post-procedure markers after SVAB has become widespread, with most institutions, including ours, routinely placing the markers after all breast biopsies. Studies have shown that clear margins are obtained in 90-92% of excisional specimens when lesions are localized using biopsy markers vs 31-62% when wire localization is used alone.…”

“…Studies have shown that clear margins are obtained in 90-92% of excisional specimens when lesions are localized using biopsy markers vs 31-62% when wire localization is used alone. 2,3 A well-known complication of marker use is the immediate displacement from the biopsied lesion. Most cases of displacement are believed to be caused by the so-called "accordion effect".…”

“…Most cases of displacement are believed to be caused by the so-called "accordion effect". 2,[4][5][6][7][8][9] During the SVAB procedure and subsequent marker placement, the breast is in compression. After the procedure, when released from compression, the breast resumes its normal shape and the marker can displace along the axis of compression (the z-axis).…”

“…Others were simply deposited within or near the biopsy cavity. 2,4 Use of bare metallic biopsy markers continues today at many institutions. Performance of these markers is variable, with reported rates of displacement ,10 mm ranging from 54 to 99% in the literature.…”