Improvement of Consistency in Delineating Breast Lumpectomy Cavity Using Surgical Clips

Atrchian, Siavash; Sadeghi, Parisa; Cwajna, Wladyslawa; Helyer, Lucy; Rheaume, D.; Nolan, Maureen; Rutledge, Robert; Calverley, V.; Bennett, Stephanie L.; Robar, James L.

doi:10.1016/j.ijrobp.2013.06.606

Cited by 2 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite being a standard in tumor bed marking, Yang et al (9) report the accuracy of clips representing the original tumor site is debatable as they: may be displaced with full thickness closure of the surrounding tissue, thus not correlate with the true extent of the cavity; may not be easily visualized on portal images and only provide a single point of reference for a margin, leading observers to interpolate the border of the cavity (2,12,(21)(22)(23)(24)(25)(26)(27)(28), potentially contributing to inaccuracy in target delineation for XRT. Radiation oncologists report alterations in delivered therapy secondary to clip placement (11,24,27,29).…”

Section: Surgical Clipsmentioning

confidence: 99%

See 1 more Smart Citation

A novel, adaptable, radiographically opaque, multi-plane continuous filament marker for optimizing tissue identification, radiation planning, and radiographic follow-up

Mitchell¹,

Lee²,

Dupree³

et al. 2019

Gland Surg

View full text Add to dashboard Cite

Background: In breast cancer treatment, marking the tumor bed is an important aspect of the surgical component of therapy. Clear delineation of the tumor bed allows radiation oncologists a defined target for planning and delivering postoperative radiation therapy (XRT). Tumor bed marking also allows radiographic follow-up of the tumor bed on subsequent breast imaging. The aim of this assessment is to evaluate the ease and feasibility of utilizing a tumor bed filament marker (VeraForm  , Videra Surgical inc., USA) as a marker in post-operative benign surgical sites and malignant breast surgical tumor beds in breast cancer surgery. Methods:The filament marker is a novel radiopaque surgical filament that in lieu of clips and other markers is implanted in the surgical tumor bed during breast surgery. Following development of the filament marker, the researchers used breast phantoms and radiographic images to develop a series of geometric patterns of placement options that optimize comprehensive multi-plane radiographic interpretation of the exact tumor bed or surgical margin. Three breast surgeons at 3 separate institutions then used this filament as a continuous multi-plane marker in 20 patients during breast conservation surgery. In these patients, the filament marker was thus used to mark the tumor bed (breast cancer surgery) or surgical site (benign breast disease) instead of the more traditional devices such as clips or other metallic open framework devices.We then assessed 2 important factors related to this device; (I) the ease, feasibility, and accuracy of in vivo placement with oncoplastic and non-oncoplastic breast conservation surgery techniques; (II) the radiographic footprint this device left on standard imaging protocols of post-operative mammogram (MMG), computed tomography (CT) scan, breast magnetic resonance imaging (MRI) examinations, and ultrasounds (USs) for both routine follow-up imaging and for standard radiation planning.Results: There were no adverse events reported with the use of this device. The cases were then reviewed by a multidisciplinary team that included the original surgeon, a breast radiologist, and radiation oncologist.Their unanimous evaluation was that the filament marker clearly delineated all sides and planes of the tumor bed (cancer surgery) or surgical site (benign disease). Regardless of surgical technique utilized, this information provided precise 3D guidance for radiation planning and delivery as well as radiographic followup. The surgeons involved reported that delineating the bed with the filament marker was a quick and easy procedure and did not interfere with performing the planned surgical technique. Radiologists, surgeons, 610 Mitchell et al. Continuous radiopaque filament marker

show abstract

Section: Surgical Clipsmentioning

confidence: 99%

“…The exact recommended placement and number of surgical clips for tumor bed identification with radiation planning varies (2,18,(21)(22)(23)(24)28,29). Clips have been reported to move or 'migrate' from their initial placement location (9,24,25,(30)(31)(32).…”

Section: Surgical Clipsmentioning

confidence: 99%

A novel, adaptable, radiographically opaque, multi-plane continuous filament marker for optimizing tissue identification, radiation planning, and radiographic follow-up

Mitchell¹,

Lee²,

Dupree³

et al. 2019

Gland Surg

View full text Add to dashboard Cite

show abstract

“…Kirova et al 14 studied the relationship between the gross tumor volume defined on the preoperative images and clips with a 5 mm margin on the postoperative scan in 22 patients: the accuracy of tumor bed delineation was improved if 3 or more clips were placed during the lumpectomy. Atrchian et al 15 found that the consistency of tumor bed delineation was significantly improved in the craniocaudal dimension by the presence of surgical clips. Postoperative seroma in the lumpectomy cavity and clear visualization of the seroma on CT images reduces interobserver variation although the presence of seroma could increase the average tumor bed volume.…”

mentioning

confidence: 99%