Advantages and Challenges of Using Breast Biopsy Markers

Abstract

Percutaneous image-guided biopsy procedures are the standard of care for histologic assessment of suspicious breast lesions. Post-biopsy tissue markers (clips) optimize patient management by allowing for assessment on follow-up imaging and precise lesion localization. Markers are used to ensure accurate correlation between imaging modalities, guide preoperative localization for malignant and high-risk lesions, and facilitate accurate identification of benign lesions at follow-up. Local practices differ widely, and there are no data detailing the exact frequency of use of clips for different breast biopsies. There are many indications for biopsy marker deployment, and some difficulties may be encountered after placement. The placement of biopsy markers has many advantages and few disadvantages, such that deployment should be routinely used after percutaneous biopsy procedures with rare exception.

Using US Twinkling Artifact to Identify Breast Biopsy Markers: Brief Report

“…While most commercial biopsy markers are made of metal or generally hyperechoic materials, their small US scattering cross-sections may inhibit their visibility in complicated scattering tissue like the breast or the axilla, especially if not encountering the object at a favorable angle for obtaining strong reflectivity. Larger markers, such as the Tumark series that take advantage of the temperature-dependent expansion of nitinol, are not consistently readily visible on B-mode US images ( 1 , 3 , 4 ). The cork, a smaller (1.4 × 1.4 × 3.0 mm) marker, is challenging to detect on B-mode US images, but it exhibits an appreciable twinkling signature.…”

“…There is a clinically unmet need to make breast biopsy markers more sonographically conspicuous for localization purposes ( 1 – 3 ). In the setting of favorable response to neoadjuvant systemic therapy, biopsy markers can be challenging to localize, with studies showing up to 24% of patients exhibiting sonographically occult markers at the time of preoperative localization ( 4 , 5 ).…”

Evolution of localization methods for non-palpable breast lesions: a literature review from a translational medicine perspective

“…Intraoperative ultrasound-detected marker localization is a method that has been developed to improve the visibility under ultrasound for small or vague lesions ( 38 ). US-visible markers are placed after the core needle biopsy for precise breast lesion localization pre-operatively and intraoperatively ( 39 ). Apart from US, breast biopsy marker localization can also utilize mammogram, MRI, and CT guidance.…”

“…Non-metal alternatives include carbon-coated ceramic and polyetherketoneketone (PEKK). Subsequent improvements involve markers of various shapes, such as omega and round coil, to make it easier to delineate from body tissue ( 39 ). A later generation consists of an additional hydrogel body surrounding the marker: Hydrogel clips (e.g., HydroMARK ® and others) ( Figure 1 ) ( 41 ).…”