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Technical Innovation |
1 All authors: Department of Radiology, Indiana University School of Medicine, Rm. 0279, 550 N. University Blvd., Indianapolis, IN 46202.
Received February 14, 2000;
accepted after revision March 21, 2000.
Address correspondence to D. R. Baker.
Introduction
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Between April 1997 and January 2000, 408 marker clips (MicroMark or MicroMark II; Ethicon Endo-Surgery, Cincinnati, OH) were deployed in conjunction with vacuum-assisted biopsy procedures at our institution. During this period, we are aware of two patients who reported persistent emotional distress related to the presence of this foreign object in the breast. Both patients had benign disease diagnosed at vacuum-assisted biopsy and required no further intervention. However, their unease was severe enough that they sought surgical removal of the marker several months after placement. The first patient underwent needle-localized surgical excision. The second was offered the choice of attempted percutaneous removal. This procedure was successfully accomplished and is reported here.
The patient was a 58-year-old woman who underwent an uncomplicated stereotactic (Lo-Rad StereoGuide DSM; TREX Medical, Danbury, CT), vacuum-assisted (Mammotome; Ethicon Endo-Surgery) needle biopsy of her right breast because of a 5-mm cluster of suspicious microcalcifications detected on routine screening mammography. During the course of the biopsy, the entire abnormality was removed, and a MicroMark II marker clip was deployed at the biopsy site. Histology revealed fibrocystic change and microcalcifications; the patient was advised to undergo follow-up mammography in 6 months. Approximately 3 months later, we were contacted by the patient who informed us that she was uncomfortable about having the marker in her breast permanently and wished to have it removed. Efforts at reassurance were unsuccessful. The patient was not eager to undergo a surgical procedure, so we offered to attempt percutaneous removal.
The extraction procedure was identical to that used for vacuum biopsy. The patient was placed on a dedicated prone biopsy table (Lo-Rad StereoGuide DSM; TREX Medical) and positioned for the shortest approach to the target. The target was easily identified on a scout image, and stereoradiographs were obtained to calculate its x-, y-, and z-axis coordinates. A point approximately 3 mm below (positive y-axis) the target was selected as the position for the biopsy probe. The intent was to place the biopsy chamber just below the marker and to extract it with the specimen at the 12-o'clock position. After sterile preparation and administration of a local anesthetic, a small incision was made and an 11-gauge vacuum-assisted biopsy probe (Mammotome; Ethicon Endo-Surgery) was advanced to a point 2 mm from the predetermined final probe position. Stereoradiography before firing (Fig. 1A) showed acceptable positioning. The device was then fired. Stereoradiography after firing (Fig. 1B) showed the marker to be just outside the biopsy chamber. Specimens were obtained at 12-o'clock, 1-o'clock, 2-o'clock, and 11-o'clock positions. These specimens were visually inspected for evidence of the marker, but it was not seen. Specimen radiography was then performed and showed the marker to be embedded in the specimen at the 12-o'clock position (Fig. 1D). There were no complications.
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In summary, we have described the percutaneous extraction of a tissue marker using a vacuum-assisted biopsy device. Reynolds et al. [4] have reported that 88% of clusters of microcalcifications smaller than 5 mm in diameter are completely excised during the course of a vacuum-assisted biopsy. Thus, given the 2-mm size of the tissue marker, extraction is not technically challenging.
It is rare that a patient becomes so distraught about the presence of a marker clip in her breast that she demands to have it removed. In most cases, gentle reassurance regarding the safety and positional stability of these devices is all that is required to provide peace of mind. When the patient insists on removal of the marker, the technique described here provides a viable alternative to surgery.
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 E. S. Burnside, R. E. Sohlich, and E. A. Sickles Movement of a Biopsy-Site Marker Clip after Completion of Stereotactic Directional Vacuum-assisted Breast Biopsy: Case Report Radiology, November 1, 2001; 221(2): 504 - 507. [Abstract] [Full Text] [PDF]
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