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Lee SYS, Win T, Lee YS, Teo SY. Sonographic visibility of the UltraCorTM TwirlTM tissue marker. Breast Dis 2023; 41:535-543. [PMID: 36683492 DOI: 10.3233/bd-210078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Tissue markers are inserted into the breast after percutaneous biopsy to mark the site of the lesion to facilitate potential re-localisation. Tissue markers are increasingly developed with improved sonographic visibility due to benefits conferred by ultrasound-guided localisation. OBJECTIVES We aim to study the sonographic visibility of the recently-introduced UltracorTM TwirlTM tissue marker and feasibility of its pre-operative localisation under ultrasound guidance. METHODS All patients who underwent insertion of the UltracorTM TwirlTM tissue marker in our institution from July 2017 to December 2018 were reviewed. Retrospective data including sonographic visibility, evidence of migration and rate of successful surgical excision were collected. RESULTS All tissue markers were visible on subsequent ultrasound with 198 (85.0%) well-visualised with high degree of confidence while 35 (15.0%) were moderately well-visualised with moderate level of confidence. None of the tissue markers were poorly visualised and none demonstrated migration. No statistical difference in sonographic visibility is seen based on interval duration between deployment and subsequent ultrasound assessment or depth of tissue marker. CONCLUSION UltracorTM TwirlTM demonstrates consistent sonographic visibility, identifiable with a high or moderate level of confidence with no associated migration. Its use in pre-operative localisation with ultrasound guidance is therefore both reliable and feasible.
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Affiliation(s)
| | - Thida Win
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore
| | - Yien Sien Lee
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore
| | - Sze Yiun Teo
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore
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Hossam A, El-Badrawy A, Khater A, Setit A, Roshdy S, Abdelwahab K, Hamed E. The Evaluation of a Cost-Effective Method for Tumour Marking Prior to Neo-Adjuvant Chemotherapy Using Silver Rods. Eur J Breast Health 2023; 19:99-105. [PMID: 36605477 PMCID: PMC9806934 DOI: 10.4274/ejbh.galenos.2022.2022-10-3] [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: 11/08/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022]
Abstract
Objective The lack of objective documentation of pre-neoadjuvant chemotherapy (NAC) tumour margins is a major constraint in performing safe breast conserving surgery (BCS) in patients with breast cancer. Using a novel method of marking pre-NACT tumour margins with indigenous silver wire markers, this retrospective observational study attempted to assess the feasibility of safe BCS in breast cancer patients by performing excision wide of the marked pre-NACT margins. Materials and Methods This retrospective observational study was conducted on breast cancer patients who were attending our oncology centre between May, 2015 and April, 2022. All patients had received NAC followed by surgery as recommended by our multidisciplinary team. All the patients had a primary operable solitary breast cancer. We used radiopaque metallic rods made from silver to localize tumour margins prior to NAC. Results Sixty-four breast cancer patients were included; none had marker-related complications. Following NAC, BCS could be easily performed in 60 patients guided by the silver markers, which were used as temporary implants and removed during surgery. Only 2 patients were seen with positive margins and were converted to mastectomy. Conclusion Breast cancer localization using sterile silver markers before the initiation of NAC is safe, easy, inexpensive, and effective, causing no morbidity or significant pain to the patients.
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Affiliation(s)
- Amr Hossam
- Department of Surgery, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel El-Badrawy
- Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ashraf Khater
- Department of Surgery, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt,* Address for Correspondence: E-mail:
| | - Ahmed Setit
- Department of Surgery, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sameh Roshdy
- Department of Surgery, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khaled Abdelwahab
- Department of Surgery, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Emad Hamed
- Department of Surgery, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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El-bakoury E, Abd El Maksoud WM, Sultan MH, Elwany YN, Bawahab MA, Ahmed YS, Mehanna AA. Ultrasound-guided percutaneous insertion of small vascular surgical clips versus dedicated breast mammoclips as markers for breast cancer prior to neo-adjuvant therapy: a prospective randomized controlled trial. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022; 53:262. [DOI: 10.1186/s43055-022-00922-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/30/2022] [Indexed: 09/02/2023] Open
Abstract
Abstract
Aim
To investigate the feasibility of applying small vascular surgical clips as tissue markers for breast cancer in patients scheduled for neoadjuvant chemotherapy (NAC) in comparison with the dedicated breast clips with assessment of their different complications.
Patients and methods
This prospective randomized controlled trial included 160 female patients with breast cancer whose neoadjuvant chemotherapy was required for their management. Patients were randomly allocated into 2 groups; group I for patients who were subjected to the insertion of the small vascular surgical clips, and Group II for patients who were subjected to the insertion of the dedicated breast clips (UltraClips®). Assessment of the feasibility of the application of the vascular surgical clips and detection of the complications of the vascular surgical clips compared to the UltraClip® commercial clips were the endpoints of this study.
Results
Vascular surgical clips application had significantly longer duration than the duration of application of the UltraClips® (9.10 ± 2.67 min, and 5.44 ± 1.09 min respectively, P < 0.001). The application of vascular surgical clips was feasible in all patients. There were more incidences of non-deployment (6 patients) and mal-deployment (4 patients) in group I, compared to one patient and 2 patients in group II, respectively. All patients of non-deployment and mal-deployment in both groups had reapplication of other clips successfully. There were no significant differences between the two groups regarding incidence of complications.
Conclusions
The spinal needle/surgical vascular clip technique seems to be a cheap and effective alternative to the dedicated commercial mammoclips when required, with convenient results and minimal complications.
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Abdelfatah NOS, Abdallah RH, Ibrahim SF, Ahmed AI. Assessment of low-cost surgical metallic clip placement for tumor localization in BIRDAS VI breast cancer patients undergoing neoadjuvant chemotherapy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00740-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Neoadjunvant chemotherapy has become a challenging connotation for both surgeons and radiologists due to the high clinical response up to dramatic pathological complete response (pCR) that may hinder proper localization of any residual tumoral tissue. So the radiopaque markers implantation at the tumor bed became a reliable and recommended method for tumor localization before surgical intervention or NAC. Many types of commercial clips and markers are available; however they are relatively of high cost and represent a considerable burden on the governments and the heath institute that made the researchers study cheaper alternatives as standard titanium based cholecystectomy surgical clips for tumor localization.
Results
The study was conducted on 45 patients where 57 clips were inserted corresponding to number of lesions found in the total number of the patients. The response to Neoadjunvant chemotherapy was recorded and showed that 6 patients (about 13.3%) had complete radiological response after NAC, while 27 patients (60%) had regressive course after the treatment. The low cost surgical clips were evaluated by using sono-mammography and magnetic resonance imaging, and complications that occurred were recorded. Our study showed that in only 2 patients (3.5%) there was difficulty in clip visualization by Ultrasound during post-treatment follow up. In 45 patients, all the inserted clips (100%) were well visualized as small signal void on MRI at both T1WIs and T2WIs sequences, and the primary malignancy was easily visualized on both MRI and sono-mammography not interfering with the image interpretation and judgment. As regards the reported complications, our results revealed that in only 2 patients (3.5%) there was evidence of positive clip migration, while only 2 patients (3.5%) developed hematoma during the procedure as shown by ultrasound, Also 4 patients (7%) complained of pain only shortly after clip insertion. No other significant complications like infection or heat sensation developed either during the procedure or during MRI. The total price of the surgical clips was calculated with average cost of the needle about 10 US$ equivalent to 170 LE Egyptian pounds and the clip about 1.3 US$ or 20 Egyptian pounds, which is considered of lower cost when compared to the commercial breast markers of different companies with an estimated price range for clip = 75–200 US$ (average 90 US$). So insertion of surgical clips saved about 1135 Egyptian pounds equivalent to 73–75 US$ per clip placement.
Conclusion
We concluded from our study that the use of breast markers are mandatory before NAC where Surgical clips can safely substitute the commercial tissue markers as tumor localizers as they are effective, safe, well tolerated, easily visualized on imaging and do not interfere with assessment of the treatment response, with no evidence of complications and are of low cost compared with the commercial breast clips.
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Comparison of the Ultrasound Visibility of Tissue Markers in Metastatic Lymph Nodes after Neoadjuvant Chemotherapy in Patients with Breast Cancer. Diagnostics (Basel) 2022; 12:diagnostics12102424. [PMID: 36292113 PMCID: PMC9600094 DOI: 10.3390/diagnostics12102424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 11/28/2022] Open
Abstract
This study aimed to investigate the differences in ultrasound (US) visibility for the localization of clipped metastatic lymph nodes after neoadjuvant chemotherapy (NAC), according to tissue marker type. This single-center retrospective study included 59 consecutive patients with breast cancer who underwent tissue marker insertion for histologically proven metastatic axillary lymph nodes before NAC, between March 2020 and August 2021. Two breast tissue markers were used: UltraClip™ (n = 29) and UltraCor™ Twirl™ (n = 30). The US visibility of tissue markers after NAC and the successful excision rate of the clipped lymph nodes were compared between the two types of tissue markers. UltraCor™ Twirl™ showed better overall US visibility than UltraClip™ after NAC (86.7% vs. 72.4%), but the difference was statistically insignificant. In the absence of residual metastatic lymph nodes on US after NAC (n = 32), UltraCor™ Twirl™ showed significantly better US visibility (83.3%, 15/18) than UltraClip™ (42.9%, 6/14; p = 0.027). The marker type was not associated with the successful excision of the clipped lymph node. UltraCor™ Twirl™ showed better US visibility than UltraClip™ in the metastatic axillary lymph nodes after NAC in the absence of residual suspicious lymph nodes on US.
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Minella C, Villasco A, D’Alonzo M, Cellini L, Accomasso F, Actis S, Biglia N. Surgery after Neoadjuvant Chemotherapy: A Clip-Based Technique to Improve Surgical Outcomes, a Single-Center Experience. Cancers (Basel) 2022; 14:cancers14092229. [PMID: 35565357 PMCID: PMC9103394 DOI: 10.3390/cancers14092229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: This study aims to describe the surgical management of breast cancer patients after neoadjuvant chemotherapy, with attention to the impact on surgical outcomes of a clip-based marking technique. Methods: Patients who underwent NACT at the Breast Unit of the A. O Ordine Mauriziano of Turin from January 2018 and had a surgical intervention by January 2022 were included. Data on the feasibility of clip insertion, after-treatment visibility, and successful removal during surgery were collected prospectively. Surgical outcomes in terms of breast-conserving surgery and axillary dissection reduction were described. Results: In 51 patients who had surgery after NACT, 55 clips were placed (34 breast and 21 axillary clips). Ultrasound visibility of the clips was optimal (91%) as well as preoperative localization and retrieval within the surgical specimen. Moreover, the use of the clip positively affected surgical outcomes. In our study, clip insertion allowed to avoid mastectomy and axillary dissection in patients with a complete radiological response. Conclusions: In our findings, the use of breast and/or lymph node clips has proved to be a simple and effective method to improve surgical conservative management of breast cancer patients after NACT.
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Affiliation(s)
- Carola Minella
- Academic Division of Obstetrics and Gynaecology, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (C.M.); (A.V.); (M.D.); (F.A.); (S.A.)
| | - Andrea Villasco
- Academic Division of Obstetrics and Gynaecology, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (C.M.); (A.V.); (M.D.); (F.A.); (S.A.)
| | - Marta D’Alonzo
- Academic Division of Obstetrics and Gynaecology, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (C.M.); (A.V.); (M.D.); (F.A.); (S.A.)
| | - Lisa Cellini
- Radiology Department, A.O. Ordine Mauriziano, 10128 Turin, Italy;
| | - Francesca Accomasso
- Academic Division of Obstetrics and Gynaecology, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (C.M.); (A.V.); (M.D.); (F.A.); (S.A.)
| | - Silvia Actis
- Academic Division of Obstetrics and Gynaecology, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (C.M.); (A.V.); (M.D.); (F.A.); (S.A.)
| | - Nicoletta Biglia
- Academic Division of Obstetrics and Gynaecology, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (C.M.); (A.V.); (M.D.); (F.A.); (S.A.)
- Correspondence:
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Taylor DB, Bourke AG, Westcott EJ, Marinovich ML, Chong CYL, Liang R, Hughes RL, Elder E, Saunders CM. Surgical outcomes after radioactive 125I seed versus hookwire localization of non-palpable breast cancer: a multicentre randomized clinical trial. Br J Surg 2021; 108:40-48. [PMID: 33640932 PMCID: PMC10364908 DOI: 10.1093/bjs/znaa008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/19/2020] [Accepted: 08/30/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Previous studies have suggested improved efficiency and patient outcomes with 125I seed compared with hookwire localization (HWL) in breast-conserving surgery, but high-level evidence of superior surgical outcomes is lacking. The aim of this multicentre pragmatic RCT was to compare re-excision and positive margin rates after localization using 125I seed or hookwire in women with non-palpable breast cancer. METHODS Between September 2013 and March 2018, women with non-palpable breast cancer eligible for breast-conserving surgery were assigned randomly to preoperative localization using 125I seeds or hookwires. Randomization was stratified by lesion type (pure ductal carcinoma in situ (DCIS) or other) and study site. Primary endpoints were rates of re-excision and margin positivity. Secondary endpoints were resection volumes and weights. RESULTS A total of 690 women were randomized at eight sites; 659 women remained after withdrawal (125I seed, 327; HWL, 332). Mean age was 60.3 years in the 125I seed group and 60.7 years in the HWL group, with no difference between the groups in preoperative lesion size (mean 13.2 mm). Lesions were pure DCIS in 25.9 per cent. The most common radiological lesion types were masses (46.9 per cent) and calcifications (28.2 per cent). The localization modality was ultrasonography in 65.5 per cent and mammography in 33.7 per cent. The re-excision rate after 125I seed localization was significantly lower than for HWL (13.9 versus 18.9 per cent respectively; P = 0.019). There were no significant differences in positive margin rates, or in specimen weights and volumes. CONCLUSION Re-excision rates after breast-conserving surgery were significantly lower after 125I seed localization compared with HWL. Registration number: ACTRN12613000655741 (http://www.ANZCTR.org.au/).
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Affiliation(s)
- D B Taylor
- Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia.,Division of Surgery, Medical School, University of Western Australia, Crawley, Perth, Western Australia, Australia.,BreastScreen WA, Perth, Western Australia, Australia
| | - A G Bourke
- Division of Surgery, Medical School, University of Western Australia, Crawley, Perth, Western Australia, Australia.,BreastScreen WA, Perth, Western Australia, Australia.,Breast Centre, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia
| | - E J Westcott
- Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia.,School of Physics, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - M L Marinovich
- School of Public Health, Curtin University, Bentley, Perth, Western Australia, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - C Y L Chong
- Monash Health School of Clinical Sciences, Monash University, Clayton, Melbourne, Victoria, Australia
| | - R Liang
- Department of Surgery, Gold Coast Hospital and Health Service, Robina, Queensland, Australia
| | - R L Hughes
- Radiology Department, Waikato District Health Board, Hamilton, New Zealand
| | - E Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Westmead, Sydney, New South Wales, Australia
| | - C M Saunders
- Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia.,Division of Surgery, Medical School, University of Western Australia, Crawley, Perth, Western Australia, Australia.,Breast Centre, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia.,Department of Surgery, St John of God Hospital, Subiaco, Perth, Western Australia, Australia
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8
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Cha C, Lee J, Kim D, Park S, Bae SJ, Eun NL, Ahn SG, Son EJ, Jeong J. Comparison of resection margin status after single or double radiopaque marker insertion for tumor localization in breast cancer patients receiving neoadjuvant chemotherapy. Breast Cancer Res Treat 2020; 184:797-803. [PMID: 32909180 DOI: 10.1007/s10549-020-05907-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/01/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Insertion of radiopaque markers is helpful for tumor localization in patients receiving neoadjuvant chemotherapy (NAC) followed by breast-conserving surgery (BCS). The aim of this retrospective study was to investigate the pathologic margin status in patients with single or double marker insertion. METHODS We reviewed the records of 130 patients with marker insertion prior to NAC followed by BCS from January 2016 to September 2019. Under ultrasonography guidance, single or double markers were inserted to localize a tumor in the breast. The incidence of additional resection after frozen biopsy and re-excision after permanent pathologic diagnosis was analyzed. RESULTS In a total of 130 patients, 104 had a single marker in the center of the tumor and 26 had double markers at the periphery of the tumor before NAC. Among 69 patients with residual invasive tumors after NAC, there was no difference in the additional resection rate after frozen biopsy (single vs. double markers; 14.3% vs. 38.5%, P = .059) or the re-excision rate after final pathologic diagnosis (0% vs. 7.7%, P = .188). After propensity score matching for tumor size and subtypes, the two groups showed no differences in the additional resection rate after frozen biopsy (7.7% vs. 19.2%, P = .139) or the re-excision rate (0% vs. 3.8%, P = .308). After a median follow-up of 19 months (range 8-48 months), local recurrence-free survival did not differ between the two groups (log-rank P = .456). CONCLUSIONS Number of inserted markers for tumor localization did not affect the pathologic margin status after BCS.
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Affiliation(s)
- Chihwan Cha
- Department of Surgery, Hanyang University College of Medicine, Seoul, South Korea
| | - Janghee Lee
- Department of Surgery, Dongtan Sacred Heart Hospital Hallym University, Hwaseong, Gyeonggi, South Korea
| | - Dooreh Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 712 Eonjuro, Gangnam-gu, Seoul, South Korea
| | - Soeun Park
- Department of Surgery, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Gyeonggi, South Korea
| | - Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 712 Eonjuro, Gangnam-gu, Seoul, South Korea
| | - Na Lae Eun
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 712 Eonjuro, Gangnam-gu, Seoul, South Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 712 Eonjuro, Gangnam-gu, Seoul, South Korea.
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