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Related Experiment Videos

Clip migration in stereotactic biopsy.

Rena Kass1, Grace Kumar, V Suzanne Klimberg

  • 1Department of Surgical Oncology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.

American Journal of Surgery
|October 18, 2002
PubMed
Summary

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Significant clip migration after vacuum-assisted core biopsy (VACB) can lead to positive margins in subsequent needle localization breast biopsies (NLBB). Ultrasound-guided biopsy may offer better margin control.

Area of Science:

  • Radiology
  • Surgical Oncology
  • Breast Imaging

Background:

  • Needle localization breast biopsy (NLBB) is standard after vacuum-assisted core biopsy (VACB).
  • NLBB has limitations including miss rates (0-22%), high positive margin rates (~50%), and vasovagal reactions (~20%).
  • Clip migration after VACB is hypothesized to contribute to positive margin rates in NLBB.

Purpose of the Study:

  • To evaluate the clinical significance of clip migration after VACB.
  • To determine if clip migration impacts positive margin rates in NLBB.
  • To compare NLBB with hematoma-directed ultrasound-guided biopsy (HUG) for margin status.

Main Methods:

  • Retrospective review of post-VACB mammograms with clip placement.
  • Measurement of clip-to-biopsy site distance using stereotactic images and the Pythagorean Theorem.

Related Experiment Videos

  • Review of pathology reports for margin status after NLBB or HUG.

    • Main Results:

    • Mean clip migration was 13.5 mm (range 0-78.3 mm) in 93 evaluable cases.
    • 21.5% of patients had clips migrating over 20 mm from the target site.
    • Margin positivity was 60% after NLBB versus 0% after HUG in cancer subgroups.

    Conclusions:

    • Significant clip migration after VACB is common and may explain high positive margin rates in NLBB.
    • Surgeons should not solely rely on clip location for NLBB; potential migration must be considered.
    • Hematoma-directed ultrasound-guided biopsy (HUG) offers an alternative with potentially superior margin control.