Selection of Breast Biopsy Markers: Effect on Breast Imaging Procedures, Follow-up, and Costs

Breast biopsy markers have evolved from simple metallic markers to sophisticated multimaterial devices that serve critical purposes throughout the breast cancer care continuum. This evolution began at The University of Texas MD Anderson Cancer Center in the 1960s for gynecologic and head and neck tumors. After the MicroMark (Biopsys) clip was approved by the U.S. Food and Drug Administration in 1995, markers were subsequently adapted for patients with breast cancer in 1999. By 2003, markers had become the standard of care. Modern markers serve multiple clinical functions: marking biopsy sites, facilitating cross-modality imaging correlation, guiding surgical planning and radiation therapy targeting, and ensuring continuity of care across health care facilities. Long-term studies demonstrate excellent safety profiles with minimal adverse events and significant cost-effectiveness through improved surgical precision and reduced re-excision rates. Despite the widespread adoption of these markers, contemporary challenges persist, including marker migration, allergic reactions to metallic components or embedding materials, and visibility limitations on US images. However, recent technological advances address these concerns through improved marker designs, nonmetallic alternatives, and innovative detection methods. Current best practices emphasize optimal placement timing, appropriate marker selection based on patient-specific factors, migration prevention techniques, and use of Doppler US "twinkling" artifacts for enhanced US visualization. ^© The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article.