The Pathology of Breast Biopsy Site Marking Devices

Abstract

This report presents our experience with 54 cases of patients who had excision of breast lesions after deployment of radiographic biopsy site markers at the time of stereotactic biopsy. These were of two types: pellets of a resorbable copolymer of polylactic acid/polyglycolic acid (31 cases) and plugs of bovine collagen (23 cases), both containing embedded metallic clips for long-term radiographic marking. On gross examination, the pellets have a characteristic appearance similar to a soft grain of rice, whereas the collagen plugs are spongiform with variable hemorrhagic changes. Microscopically, there are distinct differences in the morphologic features of these two types of biopsy site markers and the associated tissue reactions. With the pellets, there is an initial cell-poor fibrotic reaction around empty spaces followed by a multinucleate giant cell reaction and penetration of the marker core by eosinophilic fibrinous material. The collagen plugs are recognized as eosinophilic, hyalinized, acellular material, accompanied by an inflammatory infiltrate composed predominantly of lymphocytes, plasma cells, eosinophils and, occasionally, neutrophils, which penetrate the core of the marker with time. The degradation of the collagen plug appears to be associated with infiltration of the marker by fibrovascular tissue and deposition of native collagen; of note is the absence of a significant multinucleate giant cell reaction. These novel breast biopsy site markers do not interfere with the histologic processing of the tissue or with their histopathologic interpretation.

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

“…The collagen-plug component of collagen-based markers could potentially be mistaken at pathology for local amyloidosis, due to the presence of a dense lymphoplasmacytic infiltrate stimulated by the collagen plug [59]. Thus, the type of clip used should always be specified to limit misdiagnosis [60].…”

Hygroscopic sonographically detectable clips form characteristic breast and lymph node pseudocysts

“…19 The histological appearance of localization marker sites has been characterized for different clips. 17,20 To the best of our knowledge, the specific histologic response to hygroscopic clips has not been addressed.…”

“…Most biopsy tracts, wires, and clips elicit a similar histologic response of local inflammation, foreign body reaction, fat necrosis, fibrosis, and pigment from hemosiderin deposition. 17,20 Specific markers such as collagen plugs have recognizable histologic appearance. 17 Inflammation, fibrosis, giant cell reaction, and accumulation of fibrinous material have also been described in response to hygroscopic clips with pellets containing polylactic acid/ polyglycolic acid, similar to those used today.…”

“…They include SDCs with non-absorbable material, such as Ultraclip II PVA, with polyvinyl alcohol (Bard) and clips with hygroscopic bio-absorbable organic material, including V Mark (Angiotech Pharmaceuticals, Vancouver, BC, Canada); Gel Mark Ultra (stainless steel+gel, Bard ); SecurMark (Hologic), and Hydromark (Mammotome, Cincinnati, OH, USA). The selection of the clip to be used depends on regulatory approval in specific countries, 17 economic parameters, local service considerations, and the personal preferences and experience of the radiologists and surgeons. In our center we have used the hygroscopic Hydromark clip (Mammotome).…”

“…Tissue response to breast biopsy site marking devices has been described in 2005, and was found to be dependent on the type of devices used. 17 The aim of the present study is to define and characterize the appearance of HSDC sites in breast and lymph node histopathological specimens. For this purpose, we reviewed our database for cases with documented use of HSDCs between 2014 and 2016 in our Breast Service unit, and analyzed the histopathological specimens of the patients who underwent HSDC placement.…”