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Post-Core Biopsy and Clip Placement Imaging
Ethan O. Cohen, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Top Differential Diagnoses

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Percutaneous biopsy followed by placement of radiopaque marker clip at biopsy site
              • Mammography, US, or MR imaging used to guide biopsy
            • Indications for clip placement (virtually all lesions)
              • Mammographic, US, and MR imaging correlation
                • Confirm biopsy of correct lesion
              • Facilitate preoperative localization of cancer, some risk lesions
                • Lesions with imaging-histopathology discordance require rebiopsy/excision
                • Identifies biopsy site, especially if no residual lesion after biopsy
                • Reduces challenge of reidentifying lesion and communication if different facilities perform biopsy and surgery
                • US-visible clips can be localized with US even if biopsy performed with stereotactic or MR guidance
                • After MR-guided biopsy: Mammographic localization possible, assure clip has not migrated
              • Monitor response during and facilitate excision after neoadjuvant chemotherapy (NAC)
                • Complete treatment response → lesion gone on imaging
                • Clip can serve as target for lumpectomy
                • Pathologist uses clip to identify malignancy site
                • Clip in metastatic node can facilitate localization, targeted axillary dissection
              • Awareness of biopsy site on subsequent mammograms
                • Distinguish ↓ postbiopsy scar from ↑ malignancy
                • Assess stability of biopsied lesion, residual Ca⁺⁺
              • Communication on future imaging: Avoid inadvertent rebiopsy of benign lesions

          IMAGING

          • General Features

            • Mammographic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  • Reporting Tips

                                    Selected References

                                    1. Lee AY et al: Sonographic-MRI correlation after percutaneous sampling of targeted breast ultrasound lesions: Initial experiences with limited-sequence unenhanced MRI for postprocedural clip localization. AJR Am J Roentgenol. 210(4):927-934, 2018
                                    2. Sakamoto N et al: Evaluation of the dislocation and long-term sonographic detectability of a hydrogel-based breast biopsy site marker. Breast Cancer. ePub, 2018
                                    3. Huang ML et al: Imaging-Concordant Benign MRI-Guided Vacuum-Assisted Breast Biopsy May Not Warrant MRI Follow-Up. AJR Am J Roentgenol. 208(4):916-922, 2017
                                    4. Le-Petross HT et al: Effect of mammography on marker clip migration after stereotactic-guided core needle breast biopsy. Curr Probl Diagn Radiol. 46(6):410-414, 2017
                                    5. Sakamoto N et al: Evaluation of the sonographic visibility and sonographic appearance of the breast biopsy marker (UltraClip®) placed in phantoms and patients. Breast Cancer. 24(4):585-592, 2017
                                    6. Song SE et al: Post-clip placement MRI following second-look US-guided core biopsy for suspicious lesions identified on breast MRI. Eur Radiol. 27(12):5196-5203, 2017
                                    7. Monticciolo DL et al: Six-month short-interval imaging follow-up for benign concordant core needle biopsy of the breast: Outcomes in 1444 cases with long-term follow-up. AJR Am J Roentgenol. 1-6, 2016
                                    8. Pinkney DM et al: A prospective comparative study to evaluate the displacement of four commercially available breast biopsy markers. Br J Radiol. 89(1065):20160149, 2016
                                    9. Johnson JM et al: Breast cancer detection with short-interval follow-up compared with return to annual screening in patients with benign stereotactic or US-guided breast biopsy results. Radiology. 275(1):54-60, 2015
                                    10. Bourke AG et al: The disappearing clip: an unusual complication in MRI biopsy. BMJ Case Rep. 2014, 2014
                                    11. Fusco R et al: Procedures for location of non-palpable breast lesions: a systematic review for the radiologist. Breast Cancer. 21(5):522-31, 2014
                                    12. Shaylor SD et al: Short interval follow-up after a benign concordant MR-guided vacuum assisted breast biopsy--is it worthwhile? Eur Radiol. 24(6):1176-85, 2014
                                    13. Manjoros DT et al: The value of 6-month interval imaging after benign radiologic-pathologic concordant minimally invasive breast biopsy. Ann Surg Oncol. 20(10):3163-8, 2013
                                    14. Monticciolo DL: Postbiopsy confirmation of MR-detected lesions biopsied using ultrasound. AJR Am J Roentgenol. 198(6):W618-20, 2012
                                    15. Seow JH et al: Sonographic visibility of breast tissue markers: a tissue phantom comparison study. Australas J Ultrasound Med. 15(4):149-157, 2012
                                    16. Venkataraman S et al: Stereotactic core biopsy: Comparison of 11 gauge with 8 gauge vacuum assisted breast biopsy. Eur J Radiol. 81(10):2613-9, 2012
                                    17. Salkowski LR et al: Utility of 6-month follow-up imaging after a concordant benign breast biopsy result. Radiology. 258(2):380-7, 2011
                                    18. Eby PR et al: Preoperative and intraoperative sonographic visibility of collagen-based breast biopsy marker clips. Acad Radiol. 17(3):340-7, 2010
                                    19. Yazici B et al: Scar formation after stereotactic vacuum-assisted core biopsy of benign breast lesions. Clin Radiol. 61:619-24, 2006
                                    20. Gombos EC et al: Collagen plug metallic marker clip: mammographic and histopathologic appearance. Breast J. 11(4):292-3, 2005
                                    21. Perlet C et al: [Clip marker placement following MR-guided vacuum biopsy of the breast] Radiologe. 45(3):230-6, 2005
                                    22. Esserman LE et al: Recognizing pitfalls in early and late migration of clip markers after imaging-guided directional vacuum-assisted biopsy. Radiographics. 24(1):147-56, 2004
                                    23. Birdwell RL et al: Clip or marker migration 5-10 weeks after stereotactic 11-gauge vacuum-assisted breast biopsy: report of two cases. Radiology. 229(2):541-4, 2003
                                    24. Lehman CD et al: Position of clip placement after vacuum-assisted breast biopsy: is a unilateral two-view postbiopsy mammogram necessary? Breast J. 9(4):272-6, 2003
                                    25. Rausch D et al: Appearance and artifacts of breast biopsy marking clips. RSNA Educational Exhibit, 2003
                                    26. Rosen EL et al: Accuracy of a collagen-plug biopsy site marking device deployed after stereotactic core needle breast biopsy. AJR Am J Roentgenol. 181(5):1295-9, 2003
                                    27. Kass R et al: Clip migration in stereotactic biopsy. Am J Surg. 184(4):325-31, 2002
                                    28. Philpotts LE et al: Clip migration after 11-gauge vacuum-assisted stereotactic biopsy: case report. Radiology. 222(3):794-6, 2002
                                    29. Burnside ES et al: Movement of a biopsy-site marker clip after completion of stereotactic directional vacuum-assisted breast biopsy: case report. Radiology. 221(2):504-7, 2001
                                    30. Rosen EL et al: Metallic clip deployment during stereotactic breast biopsy: retrospective analysis. Radiology. 218(2):510-6, 2001
                                    31. DiPiro PJ: Disappearance of a localizing clip placed after stereotactic core biopsy of the breast. AJR Am J Roentgenol. 173(4):1134, 1999
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Definitions

                                              • Percutaneous biopsy followed by placement of radiopaque marker clip at biopsy site
                                                • Mammography, US, or MR imaging used to guide biopsy
                                              • Indications for clip placement (virtually all lesions)
                                                • Mammographic, US, and MR imaging correlation
                                                  • Confirm biopsy of correct lesion
                                                • Facilitate preoperative localization of cancer, some risk lesions
                                                  • Lesions with imaging-histopathology discordance require rebiopsy/excision
                                                  • Identifies biopsy site, especially if no residual lesion after biopsy
                                                  • Reduces challenge of reidentifying lesion and communication if different facilities perform biopsy and surgery
                                                  • US-visible clips can be localized with US even if biopsy performed with stereotactic or MR guidance
                                                  • After MR-guided biopsy: Mammographic localization possible, assure clip has not migrated
                                                • Monitor response during and facilitate excision after neoadjuvant chemotherapy (NAC)
                                                  • Complete treatment response → lesion gone on imaging
                                                  • Clip can serve as target for lumpectomy
                                                  • Pathologist uses clip to identify malignancy site
                                                  • Clip in metastatic node can facilitate localization, targeted axillary dissection
                                                • Awareness of biopsy site on subsequent mammograms
                                                  • Distinguish ↓ postbiopsy scar from ↑ malignancy
                                                  • Assess stability of biopsied lesion, residual Ca⁺⁺
                                                • Communication on future imaging: Avoid inadvertent rebiopsy of benign lesions

                                            IMAGING

                                            • General Features

                                              • Mammographic Findings

                                                • Ultrasonographic Findings

                                                  • MR Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  • Image Interpretation Pearls

                                                                    • Reporting Tips

                                                                      Selected References

                                                                      1. Lee AY et al: Sonographic-MRI correlation after percutaneous sampling of targeted breast ultrasound lesions: Initial experiences with limited-sequence unenhanced MRI for postprocedural clip localization. AJR Am J Roentgenol. 210(4):927-934, 2018
                                                                      2. Sakamoto N et al: Evaluation of the dislocation and long-term sonographic detectability of a hydrogel-based breast biopsy site marker. Breast Cancer. ePub, 2018
                                                                      3. Huang ML et al: Imaging-Concordant Benign MRI-Guided Vacuum-Assisted Breast Biopsy May Not Warrant MRI Follow-Up. AJR Am J Roentgenol. 208(4):916-922, 2017
                                                                      4. Le-Petross HT et al: Effect of mammography on marker clip migration after stereotactic-guided core needle breast biopsy. Curr Probl Diagn Radiol. 46(6):410-414, 2017
                                                                      5. Sakamoto N et al: Evaluation of the sonographic visibility and sonographic appearance of the breast biopsy marker (UltraClip®) placed in phantoms and patients. Breast Cancer. 24(4):585-592, 2017
                                                                      6. Song SE et al: Post-clip placement MRI following second-look US-guided core biopsy for suspicious lesions identified on breast MRI. Eur Radiol. 27(12):5196-5203, 2017
                                                                      7. Monticciolo DL et al: Six-month short-interval imaging follow-up for benign concordant core needle biopsy of the breast: Outcomes in 1444 cases with long-term follow-up. AJR Am J Roentgenol. 1-6, 2016
                                                                      8. Pinkney DM et al: A prospective comparative study to evaluate the displacement of four commercially available breast biopsy markers. Br J Radiol. 89(1065):20160149, 2016
                                                                      9. Johnson JM et al: Breast cancer detection with short-interval follow-up compared with return to annual screening in patients with benign stereotactic or US-guided breast biopsy results. Radiology. 275(1):54-60, 2015
                                                                      10. Bourke AG et al: The disappearing clip: an unusual complication in MRI biopsy. BMJ Case Rep. 2014, 2014
                                                                      11. Fusco R et al: Procedures for location of non-palpable breast lesions: a systematic review for the radiologist. Breast Cancer. 21(5):522-31, 2014
                                                                      12. Shaylor SD et al: Short interval follow-up after a benign concordant MR-guided vacuum assisted breast biopsy--is it worthwhile? Eur Radiol. 24(6):1176-85, 2014
                                                                      13. Manjoros DT et al: The value of 6-month interval imaging after benign radiologic-pathologic concordant minimally invasive breast biopsy. Ann Surg Oncol. 20(10):3163-8, 2013
                                                                      14. Monticciolo DL: Postbiopsy confirmation of MR-detected lesions biopsied using ultrasound. AJR Am J Roentgenol. 198(6):W618-20, 2012
                                                                      15. Seow JH et al: Sonographic visibility of breast tissue markers: a tissue phantom comparison study. Australas J Ultrasound Med. 15(4):149-157, 2012
                                                                      16. Venkataraman S et al: Stereotactic core biopsy: Comparison of 11 gauge with 8 gauge vacuum assisted breast biopsy. Eur J Radiol. 81(10):2613-9, 2012
                                                                      17. Salkowski LR et al: Utility of 6-month follow-up imaging after a concordant benign breast biopsy result. Radiology. 258(2):380-7, 2011
                                                                      18. Eby PR et al: Preoperative and intraoperative sonographic visibility of collagen-based breast biopsy marker clips. Acad Radiol. 17(3):340-7, 2010
                                                                      19. Yazici B et al: Scar formation after stereotactic vacuum-assisted core biopsy of benign breast lesions. Clin Radiol. 61:619-24, 2006
                                                                      20. Gombos EC et al: Collagen plug metallic marker clip: mammographic and histopathologic appearance. Breast J. 11(4):292-3, 2005
                                                                      21. Perlet C et al: [Clip marker placement following MR-guided vacuum biopsy of the breast] Radiologe. 45(3):230-6, 2005
                                                                      22. Esserman LE et al: Recognizing pitfalls in early and late migration of clip markers after imaging-guided directional vacuum-assisted biopsy. Radiographics. 24(1):147-56, 2004
                                                                      23. Birdwell RL et al: Clip or marker migration 5-10 weeks after stereotactic 11-gauge vacuum-assisted breast biopsy: report of two cases. Radiology. 229(2):541-4, 2003
                                                                      24. Lehman CD et al: Position of clip placement after vacuum-assisted breast biopsy: is a unilateral two-view postbiopsy mammogram necessary? Breast J. 9(4):272-6, 2003
                                                                      25. Rausch D et al: Appearance and artifacts of breast biopsy marking clips. RSNA Educational Exhibit, 2003
                                                                      26. Rosen EL et al: Accuracy of a collagen-plug biopsy site marking device deployed after stereotactic core needle breast biopsy. AJR Am J Roentgenol. 181(5):1295-9, 2003
                                                                      27. Kass R et al: Clip migration in stereotactic biopsy. Am J Surg. 184(4):325-31, 2002
                                                                      28. Philpotts LE et al: Clip migration after 11-gauge vacuum-assisted stereotactic biopsy: case report. Radiology. 222(3):794-6, 2002
                                                                      29. Burnside ES et al: Movement of a biopsy-site marker clip after completion of stereotactic directional vacuum-assisted breast biopsy: case report. Radiology. 221(2):504-7, 2001
                                                                      30. Rosen EL et al: Metallic clip deployment during stereotactic breast biopsy: retrospective analysis. Radiology. 218(2):510-6, 2001
                                                                      31. DiPiro PJ: Disappearance of a localizing clip placed after stereotactic core biopsy of the breast. AJR Am J Roentgenol. 173(4):1134, 1999