Detectability of Hygroscopic Clips Used in Breast Cancer Surgery

Carmon, Moshe; Olsha, Oded; Gekhtman, David; Никитин, И. Г.; Cohen, Yamin; Messing, Michael; Lioubashevsky, Natali; Dalo, Ribhi Abu; Hadar, Tal; Golomb, Eliahu

doi:10.7863/ultra.16.02053

Cited by 18 publications

(19 citation statements)

References 32 publications

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“…The difference between the description from 2005 and the present one may stem from differences in the clips themselves, in the procedure of their placement, or from the fact that in 2005 clips were maintained in the tissue for relatively short periods up to 6 weeks, whereas nowadays the duration is longer and may reach up to 6 months. 9 The pathologic examination of a tissue containing a clip may not be considered complete if the site of the clip is not described. For example, if a hygroscopic clip was placed and viewed by the surgeon in a tumor and the pathologist finds a small malignant tumor in the tissue but can not locate the clip near it, consideration should be taken to verify that the very tumor viewed by the surgeon was indeed found in the tissue grossing.…”

Section: Discussionmentioning

confidence: 99%

“…The metal size of this clip is~2 mm. We previously found that it is sonographically visible for at least 6 months after placement, 9 tends not to be displaced with time and enables good cross-modality communication. The degradability of its hygroscopic component may be an additional advantage if the lesion does not have to be removed.…”

mentioning

confidence: 98%

“…This is specifically important in centers that practice sentinel lymph node biopsy for involved nodes following chemotherapy. [7][8][9] Ultrasound performed by clinicians is rapidly expanding in many medical fields such as anesthesia for delivering nerve blocks, trauma medicine for quick emergency room evaluation, and in breast cancer surgery. 10,11 Intraoperative ultrasound in breast conserving surgery has been shown to reduce the rate of re-operations.…”

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confidence: 99%

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Hygroscopic sonographically detectable clips form characteristic breast and lymph node pseudocysts

et al. 2018

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The use of hygroscopic sonographically detectable clips (HSDCs) has dramatically increased during the last years, especially in breast cancer patients who undergo neoadjuvant chemotherapy. The aims of this study are to define the appearance of HSDC sites in histopathological specimens, and to enable pathologists to recognize these sites and differentiate them from other lesions. We examined 124 breast cancer specimens in which the application of HSDCs was documented, 88 breast tissues and 36 lymph nodes, and analyzed the appearance of the clip site in these tissues. The clip site was clearly detected histologically in 79/88 (90%) of the breast specimens and in 29/36 (81%) of lymph node specimens. In most of the specimens, the HSDC site had a specific characteristic appearance of a pseudocyst, lined by layers of epithelioid histiocytes, sometimes with pseudopapillary formation, and with minimal or no fibrosis. This was the appearance in 69 of the breast specimens and in 23 of the lymph node specimens. In other specimens, scarring, scattered foamy macrophages and abundant siderophages were the predominant findings, as usually found in sites of other clips. As non-palpable breast lesions become more frequent, clips play a major role in the treatment of breast cancer, making them an important component of the communication among radiologists, surgeons, pathologists, and oncologists. HSDCs in tissues have a characteristic appearance with an epithelioid component. Pathologists should be able to recognize this finding, differentiate it from other breast lesions and include it in the pathology report.

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confidence: 99%

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Hygroscopic sonographically detectable clips form characteristic breast and lymph node pseudocysts

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“…This might lead to increased patient comfort. In addition, intraoperative monitoring of the removed tissue by ultrasound instead of mammography could probably confirm adequate resection by locating the clip, which would increase the efficiency of the workflow and decrease radiology costs [11]. This could result in a decrease in surgery time, re-excision rates, resection volume, and overall cost [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…Since the first description of metal clips in the late 1990s, many different clips have been developed to improve the reproducibility and reliability of breast cancer lesion marking [10,11]. Moreover, as the axillary management of biopsy-confirmed positive lymph nodes might shift from axillary lymph node dissection towards targeted axillary dissection, clip marking of affected lymph nodes might become standard procedure as well [12].…”

Section: Introductionmentioning

confidence: 99%

Using a New Marker Clip System in Breast Cancer: Tumark Vision® Clip - Feasibility Testing in Everyday Clinical Practice

Rüland¹,

Hagemann²,

Reinisch³

et al. 2018

Breast Care

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Background: This study presents first feasibility experiences with a new 3-dimensional (3D) marker clip system in clinical practice. The rate of clinical complete responses in the treatment of breast cancer patients is increasing; additionally, a change to targeted axillary dissection is being considered after neoadjuvant chemotherapy (NACT). Consequently, marker clips are needed which are reliable and easy to handle even in the axillary lymph node system. Methods: A total of 50 patients from the Breast Care Unit of the Kliniken Essen Mitte were included. Clip marking of all 50 primary breast cancer lesions as well as 23 lymph nodes was performed using the Tumark Vision® clip. Following application, the position and visibility of the marker clip were monitored and documented in 2 axes. Results: The feasibility of the Tumark Vision clip was excellent in everyday clinical practice as none of the markers dislocated. After clip marking of the tumor region and/or suspicious lymph nodes, all Tumark Vision clips could be detected in both axes. The 3D shape could be observed in all cases after application. Conclusion: The new 3D-shaped marker clip seems to be a promising tool for marking breast cancer lesions and even lymph nodes before NACT. As there are many studies ongoing to prove the feasibility of a shift from standard axillary dissection after NACT towards targeted axillary dissection, the Tumark Vision clip seems to provide good visibility even in lymph nodes after NACT. Further studies are warranted.

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Evaluation of sonographic detectability of different markers within an in vitro simulation model of the axilla

Guergan

Hoopmann

Roehm

et al. 2021

Arch Gynecol Obstet

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Purpose Clip-marking of axillary lymph nodes with initial biopsy-confirmed metastasis is required for targeted axillary dissection (TAD), which includes sentinel lymph node dissection (SLND) and selective localization and removal of the clipped targeted lymph node. There have been several studies which examined the feasibility of TAD in routine clinical use. In this context, the optimal clip visualisation was noted as one of the crucial limiting factors. We, therefore, evaluated the sonographic detectability of 10 different commercially available markers within an in vitro model simulating the anatomical composition of the axilla. Methods In this standardised model consisting of porcine fat with 30 mm thickness, the visibility of a total of ten markers was analysed in all 3 planes (parallel, diagonal, orthograde) with wire guidance and then classified into either “visibility good”, “visibility moderate” or “visibility poor” with regard to the alignment of the transducer. Additionally, “real-life conditions” were simulated, in which the markers were searched without any wires guidance. Results It was observed that, while not all markers are detectable in fatty tissue, markers with spherical shape (non-embedded Inconel or Nitinol) or rectangular-shaped Titanium markers with embedded material have a clear advantage. 3D-shaped markers can always be detected in all three axes, which is of particular importance in the axilla with its pyramid shape and fatty tissue. Conclusion The shape and the embedding of the material play a crucial role for visibility and efficacy of the marker, as reliable marking of suspicious and pathological axillary lymph nodes is essential for TAD.

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Detectability of Hygroscopic Clips Used in Breast Cancer Surgery

Cited by 18 publications

References 32 publications

Hygroscopic sonographically detectable clips form characteristic breast and lymph node pseudocysts

Hygroscopic sonographically detectable clips form characteristic breast and lymph node pseudocysts

Using a New Marker Clip System in Breast Cancer: Tumark Vision® Clip - Feasibility Testing in Everyday Clinical Practice

Evaluation of sonographic detectability of different markers within an in vitro simulation model of the axilla

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