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Lee CU, Urban MW, Hesley GK, Wood BG, Meier TR, Chen B, Kassmeyer BA, Larson NB, Lee Miller A, Herrick JL, Jakub JW, Piltin MA. Long-Term Ultrasound Twinkling Detectability and Safety of a Polymethyl Methacrylate Soft Tissue Marker Compared to Conventional Breast Biopsy Markers-A Preclinical Study in a Porcine Model. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1001-1009. [PMID: 38575416 DOI: 10.1016/j.ultrasmedbio.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/21/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE We have studied the use of polymethyl methacrylate (PMMA) as an alternative biopsy marker that is readily detectable with ultrasound Doppler twinkling in cases of in vitro, ex vivo, or limited duration in vivo settings. This study investigates the long-term safety and ultrasound Doppler twinkling detectability of a PMMA breast biopsy marker following local perturbations and different dwell times in a 6-mo animal experiment. METHODS This study, which was approved by our Institutional Animal Care and Use Committee, involved three pigs and utilized various markers, including PMMA (Zimmer Biomet), 3D-printed, and Tumark Q markers. Markers were implanted at different times for each pig. Mesh material or ethanol was used to induce a local inflammatory reaction near certain markers. A semiquantitative twinkling score assessed twinkling for actionable localization during monthly ultrasounds. At the primary endpoint, ultrasound-guided localization of lymph nodes with detectable markers was performed. Following surgical resection of the localized nodes, histomorphometric analysis was conducted to evaluate for tissue ingrowth and the formation of a tissue rind around the markers. RESULTS No adverse events occurred. Twinkling scores of all markers for all three pigs decreased gradually over time. The Q marker exhibited the highest mean twinkling score followed by the PMMA marker, PMMA with mesh, and Q with ethanol. The 3D-printed marker with mesh and PMMA with ethanol had the lowest scores. All wire-localized lymph nodes were successfully resected. Despite varying percentages of tissue rind around the markers and a significant reduction in overall twinkling (p < 0.001) over time, mean PMMA twinkling scores remained clinically actionable at 6 and 5 mo using a General Electric C1-6 probe and 9L-probe, respectively. CONCLUSIONS In this porcine model, the PMMA marker demonstrates an acceptable safety profile. Clinically actionable twinkling aids PMMA marker detection even after 6 mo of dwell time in porcine lymph nodes. The Q marker maintained the greatest twinkling over time compared to all the other markers studied.
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Affiliation(s)
- Christine U Lee
- Department of Radiology, Division of Breast Imaging and Intervention, Mayo Clinic, Rochester, MD, USA.
| | - Matthew W Urban
- Department of Radiology, Division of Radiology Research, Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MD, USA
| | - Gina K Hesley
- Department of Radiology, Division of Breast Imaging and Intervention, Mayo Clinic, Rochester, MD, USA
| | | | - Thomas R Meier
- Department of Comparative Medicine, Mayo Clinic, Rochester, MD, USA
| | - Beiyun Chen
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, MD, USA
| | - Blake A Kassmeyer
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MD, USA
| | - Nicholas B Larson
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MD, USA
| | - A Lee Miller
- Biomaterials and Histomorphometry Core, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MD, USA
| | - James L Herrick
- Biomaterials and Histomorphometry Core, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MD, USA
| | - James W Jakub
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic, Jacksonville, FL USA
| | - Mara A Piltin
- Department of Surgery, Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MD, USA
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Asik M, Erdem G, Gezgin M. A Novel Color Doppler Ultrasound Artifact for Identifying Breast and Axilla Tumor Markers: Blooming-like Artifact. Acad Radiol 2024:S1076-6332(24)00341-6. [PMID: 38942644 DOI: 10.1016/j.acra.2024.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/04/2024] [Accepted: 05/18/2024] [Indexed: 06/30/2024]
Abstract
RATIONALE AND OBJECTIVES: Detection of tumor marker location in the breast and axilla using a less commonly utilized color Doppler ultrasound (CDUS) artifact. MATERIALS AND METHODS This prospective study was conducted between August and December 2023 and included consecutive patients with markers placed in the breast and axilla, both before and after neoadjuvant chemotherapy (NACT). Examinations were conducted using a 14 to 5 MHz linear array transducer with B-mode and Doppler capability. By reducing the velocity scale and increasing the color gain values, adjustments were made to create a bloom-like artifact. CDUS was performed with the ultrasound transmit frequency set between 14-5 MHz, color frequency between 6 and 7, color gain ranging from 58 to 80, and velocity scale within the range of 4.6-6.1 cm/s. RESULTS Twenty patients, with a mean age of 55.50 years ± 12.04 SD (range, 31-72), were included in the study. 14 (70%) were pre-NACT, and six (30%) were post-NACT patients. A total of 20 breast lesions and six axillary lymph nodes were marked. The breast lesions and axillary lymph nodes where the biopsy marker was placed (14 breast lesions and five axillary lymph nodes before NACT, six breast lesions and one axillary lymph node after NACT) were localized with blooming-like artifact. The average size of breast lesions was 20.95 mm ± 6.56 SD (range, 15-40). For axillary lymph nodes, the average size was 20.63 mm ± 5.01 SD (range: 31-14). CONCLUSION The blooming-like CDUS artifact is a novel and easily applicable method determining the location of metallic markers in the breast and axilla on diagnostic examinations.
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Affiliation(s)
- Murat Asik
- Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Süleyman Yalçın City Hospital, Istanbul, Turkey; Department of Radiology, Faculty of Medicine, Prof Dr Süleyman Yalçın City Hospital, Istanbul, Turkey.
| | - Gulnur Erdem
- Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Süleyman Yalçın City Hospital, Istanbul, Turkey; Department of Radiology, Faculty of Medicine, Prof Dr Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Merve Gezgin
- Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Süleyman Yalçın City Hospital, Istanbul, Turkey; Department of Radiology, Faculty of Medicine, Prof Dr Süleyman Yalçın City Hospital, Istanbul, Turkey
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Wood BG, Saracaydin R, Hara SA, Lee CU, Urban MW. Using 3-D-Printed Structures to Evaluate the Potential Causes of the Color Doppler Twinkling Signature. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:671-679. [PMID: 38331697 PMCID: PMC10977030 DOI: 10.1016/j.ultrasmedbio.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/15/2023] [Accepted: 01/05/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE The color Doppler twinkling artifact has been attributed to existing microbubbles or cavitation occurring on rough objects such as kidney stones, some breast biopsy clips, catheter guidewires and sandpaper. The objective was to investigate the correlation between the surface characteristics of helical constructs with different groove geometries and the occurrence of twinkling, as well as to identify locations conducive to bubble retention and/or cavitation. METHODS Six half-cylinders were created with a microscale 3-D printer with 5 µm resolution to replicate the geometry of twinkling helical constructs resembling catheter guidewires. Four copies of each marker including a non-twinkling control were printed. The half-cylinders had pitch (peak-to-peak distance) values ranging from 87.5 to 343 µm and amplitude (groove depth) values ranging from 41.5 to 209 µm. The half-cylinders were submerged in degassed water and optically imaged before and after ultrasound insonification to visualize bubbles on the cylinders. The cylinders remained submerged while scanning with the color Doppler mode at frequencies from 3.1 to 6.3 MHz using a GE Logiq E9 scanner and 9L linear array transducer. RESULTS Two markers exhibited twinkling: one with pitch-to-amplitude ratio of 174/210 µm/µm (0.8) that twinkled only with pre-existing bubbles on the marker; the other had a ratio of 87/87 µm/µm (1.00) that twinkled without pre-existing bubbles on the marker. CONCLUSION This work provides strong evidence that both existing bubbles and either cavitation or ultrasound wave interactions with patterned or rough surfaces are significant factors in producing the twinkling signature.
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Affiliation(s)
- Benjamin G Wood
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA.
| | | | - Seth A Hara
- Division of Engineering, Mayo Clinic, Rochester, MN, USA
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Whitman GJ. Twinkling: A Useful Adjunct for Identifying Biopsy Clips on US Images. Radiol Imaging Cancer 2023; 5:e230090. [PMID: 37505109 PMCID: PMC10413294 DOI: 10.1148/rycan.230090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Gary J. Whitman
- From the Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
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