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

Abstract

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.

Application of ultrasound-guided placement of markers for locating axillary lymph nodes of breast cancer

“…Markers have developed from simple metal materials to alloys materials supplemented by a polyvinyl alcohol (PVA) strip to increase the stability of marker positioning. Furthermore, the shapes of markers have also been updated from two-dimensional shapes (such as ribbon, loop, and wing-like) to spherical three-dimensional markers, which not only increases the effect of hemostasis and fixation, but also improves its stability and detection rate (18).…”

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

“…Since the implementation of markers for breast lesions was introduced in the 1990s, many different markers have been developed and evaluated in breast tissue [11][12][13]. However, the sonoanatomy of the breast and axilla is drastically different, as the axilla consists mainly of fatty tissue.…”

“…When this material was removed, as seen in examples of HydroMARK ® Shapes 3 and 4 and CorMARK®, the visibility of the marker was diminished (Figs. 1,3,11,12,13,14). The detectability of the marker with ultrasound is especially important to evaluate the clinical response during neoadjuvant chemotherapy.…”

“…However, the detectability of some markers was affected in the orthograde axis. Rueland et al found that 3D markers such as Tumark® Vision were easily detectable in both axes [ 13 ]. Though, this study consisted of investigation of a sole marker and a third axis was not included.…”

“…It can be hypothesised that the greater volume and the three-dimensional shape of the marker contribute to the visibility. Rueland et al observed in their study that 3D shapes showed stability in breast tissue [ 13 ]. The self-expansion of these markers contributes to this phenomenon, which is underlined with lower displacement rates [ 14 ].…”