Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct;38(4):336-344.
doi: 10.14366/usg.19004. Epub 2019 Apr 7.

Comparison of breast tissue markers for tumor localization in breast cancer patients undergoing neoadjuvant chemotherapy

Ja Ho Koo  1 , Eun-Kyung Kim  1 , Hee Jung Moon  1 , Jung Hyun Yoon  1 , Vivian Youngjean Park  1 , Min Jung Kim  1
Affiliations

Comparison of breast tissue markers for tumor localization in breast cancer patients undergoing neoadjuvant chemotherapy

Ja Ho Koo et al. Ultrasonography. 2019 Oct.

Abstract

Purpose: The purpose of this study was to compare the visibility of breast tissue markers in cases of breast cancer on ultrasonography (US) after neoadjuvant chemotherapy (NAC) and to analyze whether the type of marker affected the choice of localization method after NAC.

Methods: We included 153 tissue markers inserted within breast cancers that showed pathologically complete response (pCR) after NAC from January 2012 to April 2017. One of three types of markers (a surgical clip, Cormark, or UltraClip) was inserted. Medical records and imaging findings were retrospectively reviewed. We compared the visibility of the different types of tissue markers on US after NAC, and also compared the imaging modalities used in the preoperative localization. The chi-square test, Fisher exact test, and multiple logistic regression were used for analysis.

Results: Of the 153 tissue markers, 56 were surgical clips, 61 Cormark, and 36 UltraClip. After NAC, residual lesions were not seen on US in 42 cases (27.5%). In multivariate analysis, the visibility of the surgical clips and Cormark markers was better than that of the UltraClip markers (odds ratio [OR], 5.467; 95% confidence interal [CI], 1.717 to 17.410; P=0.004 and OR, 3.045; 95% CI, 1.074 to 8.628; P=0.036, respectively). Among the 131 cases where localization targeting the marker was required, the proportion of US-guided localizations was significantly higher when a surgical clip was used than when an UltraClip marker was used (OR, 5.566; 95% CI, 1.610 to 19.246; P=0.007) in the multivariate analysis.

Conclusion: The type of breast tissue marker affected its visibility on US in cases with pCR after NAC, which in turn affected the localization methodology.

Keywords: Breast; Localization; Surgical clip; Ultrasonography.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.. Selection process for the study population.
pCR, pathologic complete response.
Fig. 2.
Fig. 2.. Mammograms of three markers: LigaClip (A), Cormark (B), and UltraClip (C).
Fig. 3.
Fig. 3.. Visible LigaClip with ultrasound-guided localization (no residual lesion) in a 50-year-old woman with triple-negative breast cancer and no ductal carcinoma in situ.
A. Initial tumor lesion was seen on ultrasound with LigaClip. B. Only the LigaClip is visible on ultrasound after neoadjuvant chemotherapy. C. The localization needle is inserted into the lesion. D. Localization was confirmed using specimen mammogram.
Fig. 4.
Fig. 4.. Visible Cormark with ultrasound-guided localization (no residual carcinoma, fibrosis with collagen-like material deposition and giant cell reaction) in a 46-year-old woman with human epidermal growth factor receptor 2-positive breast cancer with residual ductal carcinoma in situ.
A. Initial tumor lesion was seen on ultrasound with the marker. B. Only the Cormark (marker itself [arrow], adjacent collagen [arrowhead]) is visible on ultrasound after neoadjuvant chemotherapy. C. Localization was confirmed using specimen mammogram.
Fig. 5.
Fig. 5.. Mammogram-guided localization due to the absence of a visible breast tissue marker (UltraClip) on ultrasonography (US) in a 64-year-old woman with human epidermal growth factor receptor 2-positive breast cancer with no ductal carcinoma in situ.
A. The marker is visible on mammography. B. A guided wire is located in the marker. C. No residual lesion or marker is visible on US after neoadjuvant chemotherapy.
See this image and copyright information in PMC

References

    1. Kaufmann M, von Minckwitz G, Mamounas EP, Cameron D, Carey LA, Cristofanilli M, et al. Recommendations from an international consensus conference on the current status and future of neoadjuvant systemic therapy in primary breast cancer. Ann Surg Oncol. 2012;19:1508–1516. - PubMed
    1. Kaufmann M, Hortobagyi GN, Goldhirsch A, Scholl S, Makris A, Valagussa P, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: an update. J Clin Oncol. 2006;24:1940–1949. - PubMed
    1. Edeiken BS, Fornage BD, Bedi DG, Singletary SE, Ibrahim NK, Strom EA, et al. US-guided implantation of metallic markers for permanent localization of the tumor bed in patients with breast cancer who undergo preoperative chemotherapy. Radiology. 1999;213:895–900. - PubMed
    1. Phillips SW, Gabriel H, Comstock CE, Venta LA. Sonographically guided metallic clip placement after core needle biopsy of the breast. AJR Am J Roentgenol. 2000;175:1353–1355. - PubMed
    1. Shetty MK. Presurgical localization of breast abnormalities: an overview and analysis of 202 cases. Indian J Surg Oncol. 2010;1:278–283. - PMC - PubMed

LinkOut - more resources