Ultrasound-Guided Segmental Mastectomy and Excisional Biopsy Using Hydrogel-Encapsulated Clip Localization as an Alternative to Wire Localization

Gentile, Lori F.; Himmler, Amber; Shaw, Christiana; Bouton, Amber; Vorhis, Elizabeth; Marshall, Julia; Spiguel, Lisa

doi:10.1245/s10434-016-5325-x

Cited by 14 publications

(15 citation statements)

References 21 publications

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“…HER2-positive and triple-negative breast cancers are associated with early events, but luminal cancers (the majority of cases in this series) are more frequently late-recurring, thus possible recurrences may be missed in the present study. 26 No differences were observed in surgery time between ROLL and TCC (respectively, 65 vs 62.9 minutes) despite operative time 34,35 Most of the previous studies were designed before the recent definition of adequate margins for invasive cancer and DCIS, and frequently patients with benign or uncertain lesions were included, conversely to the present study. 8,[27][28][29][30][31][32][33] Furthermore, adequacy of resection has been often evaluated on specimen volumes or weight, kind of studies since adequacy of resection is the main end-point for breast-conserving surgery of nonpalpable cancers, and current imprecisions and heterogeneity in volumes measurement have led to inconsistent or controversial results.…”

Section: Mass-like Lesions Such As Nodules or Distortions Have Been Omentioning

confidence: 78%

“…Both WGL and RSL have well known drawbacks, such as displacement, fracture or patient's discomfort in case of WGL, and an additional procedure before surgery to insert the seed, as well as radioactivity handling and disposal concerns, in case of RSL . Only a few studies have evaluated US localization of clip markers, providing encouraging results compared with WGL; however, an accurate assessment of such technique in terms of adequacy of resection volumes specifically in different lesion types is still lacking, especially compared with ROLL …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Radio‐guided vs clip‐guided localization of nonpalpable mass‐like lesions of the breast from a screened population: A propensity score‐matched study

Corsi

Bossi

Combi

et al. 2019

Journal of Surgical Oncology

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Background and Objectives An accurate localization is mandatory to tailor breast lumpectomy in nonpalpable cancers. The aim of this study was to compare radio‐guided localization (ROLL) vs ultrasound localization of a titanium clip with collagen (TCC) in nonpalpable mass‐like breast cancers. Methods Two hundred seventy‐three consecutive patients were reviewed: 64 patients were localized by TCC and 209 patients by ROLL. Propensity score‐matched analysis was performed. Margin status and reintervention rates were compared. Adequacy of resection was expressed as the calculated resection ratio (CRR) considering lesion size. Loco‐regional and distant recurrence rates were assessed with ROLL vs TCC. Results No differences were found with ROLL vs TCC in clear margins (90.6% vs 89.1%; odds ratio, 0.74; P = 0.64) or reoperations (6.7% vs 1.6%; P = 0.529). ROLL allowed more tailored resections compared with TCC (adjusted CRR, 1.7 vs 2.7; P = 0.0008), particularly in lesions with associated extensive intraductal component (CRR, 3.0 vs 4.5; P = 0.017). Loco‐regional recurrence occurred in 1.9% of ROLL patients vs 3.2% of TCC cases (P = 0.628). Conclusions ROLL and TCC are equally effective to excise nonpalpable mass‐like breast cancers with clear margins, providing similar loco‐regional control. However, ROLL allows more tailored breast resections, particularly in lesions with the associated extensive intraductal component.

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Section: Mass-like Lesions Such As Nodules or Distortions Have Been Omentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Radio‐guided vs clip‐guided localization of nonpalpable mass‐like lesions of the breast from a screened population: A propensity score‐matched study

Corsi

Bossi

Combi

et al. 2019

Journal of Surgical Oncology

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“…With improved clip visibility on ultrasound, the clipped nodes could be excised in a similar fashion as nonpalpable clipped breast lesions using ultrasound guidance alone. 7 In fact, intraoperative ultrasound-guided excision of axillary clipped node post-NACT had been reported to be feasible and safe. 19 In our case however, we advocated a multidisciplinary approach of the radiologists preoperatively placing a skin mark to further delineate the location of the clip more precisely.…”

Section: Discussionmentioning

confidence: 99%

Initial results of a novel technique of clipped node localization in breast cancer patients postneoadjuvant chemotherapy: Skin Mark clipped Axillary nodes Removal Technique (SMART trial)

et al. 2020

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Purpose Removal of clipped nodes can improve sentinel node biopsy accuracy in breast cancer patients post neoadjuvant chemotherapy (NACT). However, the current methods of clipped node localization have limitations. We evaluated the feasibility of a novel clipped node localization and removal technique by preoperative skin marking of clipped nodes and removal by the Skin Mark clipped Axillary nodes Removal Technique (SMART), with the secondary aim of assessing the ultrasound visibility of the various clips in the axillary nodes after NACT. Methods Invasive breast cancer patients with histologically metastatic axillary nodes, going for NACT, and ≤3 sonographically abnormal axillary nodes were recruited. All abnormal nodes had clips inserted. Patients with M1 disease were excluded. Post‐NACT, patients underwent SMART and axillary lymph node dissection. Specimen radiography and pathological analyses were performed to confirm the clipped node presence. Success, complication rates of SMART, and ultrasound visibility of the various clips were assessed. Results Twenty‐five clipped nodes in 14 patients underwent SMART without complications. The UltraCor Twirl, hydroMARK, UltraClip Dual Trigger, and UltraClip were removed in 13/13 (100%), 7/9 (77.8%), 1/2 (50.0%), and 0/1 (0%), respectively (P = .0103) with UltraCor Twirl having the best ultrasound visibility and removal rate. Removal of three clipped nodes in the same patient (P = .0010) and deeply seated clipped nodes (P = .0167) were associated with SMART failure. Conclusion Skin Mark clipped Axillary nodes Removal Technique is feasible for removing clipped nodes post‐NACT, with 100% observed success rate, using the UltraCor Twirl marker in patients with <3 not deeply seated clipped nodes. Larger studies are needed for validation.

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“…To date, several studies have looked at use of UVCs—more specifically, the HydroMARK clip—with US‐guided PMs . These studies found the HydroMARK clip to be an overall safe, efficient, and effective alternative to wire localization when used with US guidance for excision of early‐stage breast cancer.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Ultrasound Guidance With an Ultrasound‐Visible Clip: A Practical and Cost‐effective Option for Breast Cancer Localization

Konen

Murphy

Berkman

et al. 2019

J of Ultrasound Medicine

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Objectives-In partial mastectomy (PM) or lumpectomy, ultrasound (US) localization avoids discomfort and additional procedures associated with wire localization. The purpose of this study was to evaluate the association between ultrasound-visible clip (UVC) use at the time of biopsy and US use during resection, hypothesizing that UVCs facilitate US localization and reduce costs compared with traditional radiopaque clips or no clip placement.Methods-The study population consisted of adult female patients with breast cancer undergoing PM or lumpectomy at our institution between 2014 and 2016. The core biopsy clip type and localization method during PM were characterized as wire localization versus US localization, and associations were estimated with multivariable regression models. For the cost evaluation, breast biopsy data were obtained from the Department of Radiology.Results-Among 674 patients, 490 had data on localization and the clip type. Ultrasound-visible clip placement at biopsy increased US use during resection by 13% (95% confidence interval, 6%-21%). There was no difference in the total specimen weight with US versus wire localization. The cost savings for using UVCs for the 2209 patients who underwent breast biopsy from 2014 to 2016 was $36,000.Conclusions-This study demonstrates that US localization for PM is feasible at a single institution and cost-effective when facilitated by UVCs. Placement of a UVC at the time of biopsy is recommended, as it is cost-effective and avoids the discomfort and inconvenience of wire localization.

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Ultrasound-Guided Segmental Mastectomy and Excisional Biopsy Using Hydrogel-Encapsulated Clip Localization as an Alternative to Wire Localization

Cited by 14 publications

References 21 publications

Radio‐guided vs clip‐guided localization of nonpalpable mass‐like lesions of the breast from a screened population: A propensity score‐matched study

Radio‐guided vs clip‐guided localization of nonpalpable mass‐like lesions of the breast from a screened population: A propensity score‐matched study

Initial results of a novel technique of clipped node localization in breast cancer patients postneoadjuvant chemotherapy: Skin Mark clipped Axillary nodes Removal Technique (SMART trial)

Intraoperative Ultrasound Guidance With an Ultrasound‐Visible Clip: A Practical and Cost‐effective Option for Breast Cancer Localization

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