Evaluation of a Marker Clip System in Sonographically Guided Core Needle Biopsy for Breast Cancer Localization Before and After Neoadjuvant Chemotherapy

Abstract

Introduction The placement of intramammary marker clips has proven to be helpful for tumor localization in patients undergoing neoadjuvant chemotherapy and breast-conserving surgery. The purpose of our study was to investigate the feasibility of using a clip marker system for breast cancer localization and its influence on the imaging assessment of treatment responses after neoadjuvant chemotherapy.

Patients and Methods Between March and June 2015, a total of 25 patients (n = 25), with a suspicion of invasive breast cancer with diameters of at least 2 cm (cT2), underwent preoperative sonographically guided core needle biopsy using a single-use breast biopsy system (HistoCore™) and intramammary clip marking using a directly adapted clip system based on the established O-Twist Marker™, before their scheduled preoperative neoadjuvant chemotherapy. Localization of the intramammary marker clip was controlled by sonography and digital breast tomosynthesis.

Results Sonography detected no dislocation of intrammammary marker clips in 20 of 25 patients (80 %), while digital breast tomosynthesis showed accurate placement without dislocation in 24 patients (96 %) (p < 0.05). There was no evidence of significant clip migration during preoperative follow-up imaging after neoadjuvant chemotherapy. No complication related to the clip marking was noted and there was no difficulty in evaluating the treatment response to neoadjuvant chemotherapy. Among the breast-conserving surgeries performed, no cases were identified in which intraoperative loss of the marker clip had occurred.

Conclusion Our study underscores the importance of intramammary marking clip systems before neoadjuvant chemotherapy. Placement of marker clips is advised to facilitate accurate tumor bed localization. With regard to digital breast tomosynthesis, its development continues to improve the quality of diagnostics and the therapy of breast cancer particularly for small breast cancer tumors or in neoadjuvant chemotherapy setting.

Zusammenfassung

Einleitung Die Platzierung intramammärer Clips zur Markierung eines Mammakarzinoms bei Patientinnen, bei denen eine neoadjuvante Chemotherapie und brusterhaltenden Therapie geplant sind, ist heutzutage ein etabliertes Verfahren. Ziel dieser Studie war es, den Einsatz eines intramammären Clipmarkierungs-Systems unter neoadjuvanter Chemotherapie zu überprüfen, und dessen möglichen Einfluss auf bildgebende Verfahren zur Beurteilung der Ansprechrate nach neoadjuvanter Chemotherapie.

Patientinnen und Methoden Im Rahmen dieser Studie wurde bei 25 Patientinnen zwischen März und Juni 2015 bei Verdacht auf ein Mammakarzinom mit einem Durchmesser von größer 2 cm (cT2), eine sonografisch gesteuerte Stanzbiopsie (HistoCore™) mit gleichzeitiger adaptierter Clipmarkierung (O-Twist Marker™) in das Tumorzentrum vor einer geplanten neoadjuvanten Chemotherapie durchgeführt. Anschließend wurde eine Lokalisationsbestimmung der intramammären Clipmarkierung sowohl durch Sonografie als auch durch eine digitale Brusttomosynthese durchgeführt.

Ergebnisse Sonografisch war bei 20 von 25 Patientinnen (80 %) keine Dislozierung der intrammammären Clips festzustellen, wohingegen die digitale Tomosynthese der Brust eine exakte Platzierung ohne Dislozierung bei 24 Patientinnen (96 %) nachwies (p < 0,05). Nach neoadjuvanter Chemotherapie ergab sich kein Anhalt für eine signifikante Dislozierung in der präoperativen Verlaufskontrolle. Des Weitern gab es weder Komplikationen im Zusammenhang mit der Clipmarkierung noch Schwierigkeiten bei der Bestimmung der Ansprechraten nach der neoadjuvanten Chemotherapie. Unter allen Patientinnen, die sich einer brusterhaltenden Therapie unterzogen, gab es keine Fälle mit intraoperativem Verlust des Markierungsclips.

Schlussfolgerung Unsere Studie hebt die Bedeutung einer intramammären Clipmarkierung vor einer neoadjuvanten Chemotherapie hervor. Eine Platzierung von Markierungsclips wird empfohlen, um die präzise Lokalisierung von Brusttumoren zu erleichtern. Was die digitale Tomosynthese der Brust anbetrifft, wird die kontinuierliche Weiterentwicklung dieses bildgebenden Verfahrens die Qualität der Diagnostik und Therapie des Mammakarzinoms weiter verbessern, besonders bei kleinen Tumoren bzw. bei neoadjuvanter Chemotherapie.

Key words

breast cancer - neoadjuvant chemotherapy - intramammary clip marker - digital breast tomosynthesis (DBT)

Schlüsselwörter

Brustkrebs - neoadjuvante Chemotherapie - intramammäre Clipmarkierung - digitale Tomosynthese der Brust (DBT) - Mammakarzinom

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