Tissue marker migration after MRI‐guided breast biopsy: Migration frequency and associated factors

Sustained delivery of celecoxib from nanoparticles embedded in hydrogel injected into the biopsy cavity to prevent biopsy-induced breast cancer metastasis

PURPOSE

We have previously reported that protracted Cyclooxygenase-2 (COX-2) activity in bone marrow-derived cells (BMDCs) infiltrating into biopsy wounds adjacent to the biopsy cavity of breast tumors in mice promotes M2-shift of macrophages and pro-metastatic changes in cancer cells, effects which were suppressed by oral administration of COX-2 inhibitors. Thus, local control of COX-2 activity in the biopsy wound may mitigate biopsy-induced pro-metastatic changes.

METHODS

A combinatorial delivery system-thermosensitive biodegradable poly(lactic acid) hydrogel (PLA-gel) incorporating celecoxib-encapsulated poly(lactic-co-glycolic acid) nanoparticles (Cx-NP/PLA-gel)-was injected into the biopsy cavity of Py230 murine breast tumors to achieve local control of COX-2 activity in the wound stroma.

RESULTS

A single intra-biopsy cavity injection of PLA-gel loaded with rhodamine-encapsulated nanoparticles (NPs) showed sustained local delivery of rhodamine preferentially to infiltrating BMDCs with minimal to no rhodamine uptake by the reticuloendothelial organs in mice. Moreover, significant reductions in M2-like macrophage density, cancer cell epithelial-to-mesenchymal transition, and blood vessel density were observed in response to a single intra-biopsy cavity injection of Cx-NP/PLA-gel compared to PLA-gel loaded with NPs containing no payload. Accordingly, intra-biopsy cavity injection of Cx-NP/PLA-gel led to significantly fewer metastatic cells in the lungs than control-treated mice.

CONCLUSION

This study provides evidence for the feasibility of sustained, local delivery of payload preferential to BMDCs in the wound stroma adjacent to the biopsy cavity using a combinatorial delivery system to reduce localized inflammation and effectively mitigate breast cancer cell dissemination.

Beyond the Needle: Understanding Tissue Marker Migration in Breast MRI-Guided Biopsies

OBJECTIVE

To evaluate the frequency and factors associated with clip migration in MRI-guided breast biopsies.

METHODS

This study was approved by our Institutional Review Board and was compliant with HIPAA. We retrospectively evaluated all MRI-guided biopsies performed between January 2013 and December 2020 in our institution for clip migration. Only patients with follow-up breast MRI showing the clip were included in the study. Migration was defined as movement of the clip of 10 mm or more from the target lesion. Migration frequency and directions were recorded. Factors associated with clip migration were analyzed using statistical tests as appropriate.

RESULTS

A total of 291 biopsies in 268 women were included in the study with 31 migration events recorded (11%; 95% CI, 7%-15%). All migrations occurred along the biopsy tract; 97% (30/31) of them displaced distal to the needle entry site. More than 50% regional fat (around the target lesion) was the strongest factor associated with migration, seen in 21/141 women (15%), compared to 10/150 (7%) with 50% or less local fat (P = .023). Global fatty breast was more loosely associated with migration, showing borderline significance (P = .06). Other factors did not correlate with clip migration, including lesion size, depth, or location; pathology result; breast thickness; or biopsy approach.

CONCLUSION

Although clip migration after breast MRI-guided biopsy is an uncommon event, it occurs more often when the target lesion is surrounded by fat, with the clip usually displaced away from the needle entry site.

The Role of Predeployment Retraction in Biopsy Marker Migration During Stereotactic Breast Biopsies: A Randomized Controlled Trial

OBJECTIVE

Inaccurate breast biopsy marker placement and marker migration during stereotactic biopsy procedures compromise their reliability for lesion localization and precise surgical excision. This trial evaluated the impact of 5-mm predeployment retraction of the marker introducer on marker migration, investigating other potential factors that influence the outcome.

METHODS

This parallel, randomized controlled trial enrolled women aged ≥18 years undergoing stereotactic breast biopsy at a single institution from May 2020 through August 2022. The study was approved by the institutional review board at the University of Alabama at Birmingham (UAB). Patients were randomized to intervention (5-mm introducer retraction before marker deployment) or control (standard marker placement) by drawing a labeled paper. The primary outcome was the distance of marker migration on immediate postprocedure mammogram.

RESULTS

Of 251 patients enrolled, 223 were analyzed; 104 received the intervention, and 119 received control. Mean (SD) marker migration was 12.1 (14.9) mm in the intervention group vs 9.8 (14.9) mm, with differences between groups estimated at 2.3 mm (SE = 1.9, P = .2312) (d = 0.16; 95% CI, 1.5-6.0). Effects of age, breast density, thickness, and biopsy approach showed no statistical significance. In exploratory models, central lesions exhibited 5.7 mm less migration than proximal lesions (95% CI, 0.7-10.6; P = .025), and each body mass index (BMI) unit increase was associated with 0.3 mm greater migration (95% CI, 0-0.6; P = .044).

CONCLUSION

Retracting the marker introducer 5 mm before deployment did not reduce migration. Higher BMI and certain lesion locations were all associated with marker migration, highlighting the need to investigate biomechanical factors and techniques to optimize breast marker placement.Clinical Trials Registration: NCT04398537.

Vanishing Act: A Case Report of Missing Breast Tumour Marker

Breast tissue markers are essential in localising tumours post-neoadjuvant chemotherapy prior to breast-conserving surgery. However, due to the advancement in neoadjuvant therapies, greater efficacy in reducing tumour size increases the possibility of marker migration, potentially compromising surgical outcomes. We report a case of a 34-year-old woman with left breast invasive carcinoma, where the tissue marker, placed under ultrasound guidance before chemotherapy, migrated and was undetectable after eight chemotherapy cycles. The delay in surgery was resolved by identifying the marker in the left pectoral muscle using CT, though proximity to the lung prevented hook wire placement. Proposed migration mechanisms include the "accordion effect" and haematoma-induced displacement, highlighting the dynamic nature of breast tissue. Various imaging modalities, such as mammography, ultrasound, and CT, have proven helpful for marker localisation. This case underscores the need for a deeper understanding of tissue dynamics and emphasises interdisciplinary communication to adapt treatment strategies. As medical knowledge continues to evolve, insights are needed to refine best practices in breast cancer management and radiological interventions.

An unusual site for breast clip migration: A case report

Clip migration following breast biopsy is a known complication. However, the migrated clip is usually found within the breast. We describe a rare case of delayed clip migration to the skin, following a magnetic resonance guided biopsy of the breast, highlighting its natural history of presentation and its treatment.

[MRI-Guided Breast Intervention: Biopsy and Needle Localization]

In Korea, the number of institutions providing breast MRI, as well as the number of breast MRIs, has recently increased. However, MRI-guided procedures, including biopsy and needle localization, are rarely performed compared to ultrasound-guided or stereotactic biopsy. As breast MRI has high sensitivity but limited specificity, lesions detected only on MRI require pathologic confirmation through MRI-guided biopsy or surgical excision with MRI-guided needle localization. Thus, we aimed to review MRI-guided procedures, including their indications, techniques, procedural considerations, and limitations.

Immediate clip migration after breast biopsy: a meta-analysis for potential risk factors

OBJECTIVES

Immediate clip migration following breast biopsy is not a rare condition but its impact on future cancer management can be profound. However, there is limited knowledge on what causes the phenomenon and how to prevent it.

METHODS

A systematic search was performed to identify articles discussing factors associated with clip migration, and a meta-analysis for each risk factor was conducted to determine the risk ratio.

RESULTS

The most significant risk factor for immediate clip migration is globally fatty breast (RR = 2.00 [1.43-2.80], P<0.00001), while local heterogeneity has a moderate but insignificant protective effect (RR=0.68 [0.45-1.04], P=0.07). Clips with bioabsorbable carriers and biopsy along the superior/inferior breast axis do not change the rate of clip migration.

CONCLUSION

Intrinsic breast composition is the most important determinant for accurate clip placement. Further research to identify potentially modifiable factors, such as clip design and biopsy techniques, is needed.

ADVANCES IN KNOWLEDGE

Fatty breast composition has the highest risk of clip migration. Research on potentially modifiable factors such as clip design and biopsy techniques is needed.

Intraductal Migration of a Breast Tissue Marker Placed under Ultrasound Guidance during COVID-Induced Delay of Surgery

Breast tissue markers are common in current clinical practice and are susceptible to migration. Herein, we present the case of a 47-year-old woman with invasive breast carcinoma diagnosed through ultrasound-guided core biopsy, who underwent placement of a breast marker (HydroMARK^®) under ultrasound guidance 30 days after core biopsy and with subsequent marker migration to the nipple. The correct position of the marker was documented by mammography after its placement and by magnetic resonance imaging (MRI) after neoadjuvant chemotherapy. Migration of the marker to the nipple was evident only by mammography on the day of surgery. We hypothesized that an intraductal path was the route of marker migration in this patient. Marked ductal ectasia evident on MRI and histopathologic examination supported this hypothesis. To the best of our knowledge, this is the first published case of intraductal migration of a breast tissue marker.

MRI guided ROLL/SNOLL in breast cancer patients treated with neoadjuvant chemotherapy

PURPOSE

To describe the results of MRI (magnetic resonance image) guided ROLL (radioguided occult lesion localization) and SNOLL (sentinel node occult lesion localization) in the localization of residual disease after neoadjuvant chemotherapy for breast cancer, as well as assessing the surgical results obtained and disease free survival.

METHODS

Prospective observational analysis of 132 patients with 136 tumors, treated with neoadjuvant chemotherapy at our hospital between 2011-2017. Residual disease was located presurgically with MRI guided ROLL/SNOLL technique. We analyzed technical aspects of localization, and variables corresponding to surgical procedures and events occurred during follow-up.

RESULTS

The median tumor size was of 20.5mm (interquartilic range [IQR]: 14-28). The majority (96.3%) were invasive ductal carcinomas. Sentinel lymph node detection rate was 98.9%. Complete pathological response (CPR) in the breast was achieved in 58.1% of cases. The rate of affected margins in 89 cases operated by conservative surgery was 2.2%. With a median follow-up of 50 months (IQR: 37-61) we found a 7.4% rate of relapses. Of these, seven were loco-regional and three at distant sites. The estimated mean of disease-free survival time was 83.2 months (Confidence Interval [CI] 95%: 79.6-86.6).

CONCLUSIONS

MRI guided ROLL/SNOLL is a great tool for breast cancer residual disease localization following neoadjuvant chemotherapy. In addition, this technique attains good loco-regional control of the diseases and has excellent surgical results.

Are breast biopsy markers underused?

INTRODUCTION

To evaluate current use of breast biopsy markers (BBM) amongst Australian and New Zealand radiologists.

METHODS

Radiologists attending a national breast conference were invited to complete an online survey addressing demographics, BBM use following ultrasound, stereotactic, tomosynthesis and MRI-guided biopsy, frequency of early BBM displacement, preoperative lesion localisation (PLL) and axillary BBM use.

RESULTS

Overall response rate was 52% (60/115). The majority (n = 45) 75% practiced in Australia. 98% had BBMs available in their practice, 40% reported BBM costs weren't covered by insurance. 27% would use BBMs more often if they were, with some utilising smaller gauge devices for lesion sampling to minimise need for BBM use and patient out-of-pocket costs. Ultrasound-guided procedures were associated with lower rates of clinically significant BBM displacement (P = 0.001). Considering PLL, 44% were able to perform US-guided PLL in <25% of cases. Poor sonographic visibility was the commonest reason why this wasn't possible. In the axilla, BBMs were mainly used to mark positive nodes in pre-neoadjuvant chemotherapy patients.

CONCLUSION

This survey is the first to provide data on BBM use amongst a sample of predominantly Australian and New Zealand radiologists, and provides compelling evidence of significantly lower incidence of BBM displacement with US-guided procedures. Our results suggest some radiologists may hesitate to use BBMs due to cost, and this can influence their choice of biopsy technique. Provision of a Medicare item Number for BBMs may lead to increased adoption of best practice guidelines for preoperative diagnosis of breast lesions.