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
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
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
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
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
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
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
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
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
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
Bourke AG et al: The disappearing clip: an unusual complication in MRI biopsy. BMJ Case Rep. 2014, 2014
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
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
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
Monticciolo DL: Postbiopsy confirmation of MR-detected lesions biopsied using ultrasound. AJR Am J Roentgenol. 198(6):W618-20, 2012
Seow JH et al: Sonographic visibility of breast tissue markers: a tissue phantom comparison study. Australas J Ultrasound Med. 15(4):149-157, 2012
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
Salkowski LR et al: Utility of 6-month follow-up imaging after a concordant benign breast biopsy result. Radiology. 258(2):380-7, 2011
Eby PR et al: Preoperative and intraoperative sonographic visibility of collagen-based breast biopsy marker clips. Acad Radiol. 17(3):340-7, 2010
Yazici B et al: Scar formation after stereotactic vacuum-assisted core biopsy of benign breast lesions. Clin Radiol. 61:619-24, 2006
Gombos EC et al: Collagen plug metallic marker clip: mammographic and histopathologic appearance. Breast J. 11(4):292-3, 2005
Perlet C et al: [Clip marker placement following MR-guided vacuum biopsy of the breast] Radiologe. 45(3):230-6, 2005
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
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
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
Rausch D et al: Appearance and artifacts of breast biopsy marking clips. RSNA Educational Exhibit, 2003
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
Kass R et al: Clip migration in stereotactic biopsy. Am J Surg. 184(4):325-31, 2002
Philpotts LE et al: Clip migration after 11-gauge vacuum-assisted stereotactic biopsy: case report. Radiology. 222(3):794-6, 2002
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
Rosen EL et al: Metallic clip deployment during stereotactic breast biopsy: retrospective analysis. Radiology. 218(2):510-6, 2001
DiPiro PJ: Disappearance of a localizing clip placed after stereotactic core biopsy of the breast. AJR Am J Roentgenol. 173(4):1134, 1999
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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
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
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
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
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
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
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
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
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
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
Bourke AG et al: The disappearing clip: an unusual complication in MRI biopsy. BMJ Case Rep. 2014, 2014
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
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
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
Monticciolo DL: Postbiopsy confirmation of MR-detected lesions biopsied using ultrasound. AJR Am J Roentgenol. 198(6):W618-20, 2012
Seow JH et al: Sonographic visibility of breast tissue markers: a tissue phantom comparison study. Australas J Ultrasound Med. 15(4):149-157, 2012
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
Salkowski LR et al: Utility of 6-month follow-up imaging after a concordant benign breast biopsy result. Radiology. 258(2):380-7, 2011
Eby PR et al: Preoperative and intraoperative sonographic visibility of collagen-based breast biopsy marker clips. Acad Radiol. 17(3):340-7, 2010
Yazici B et al: Scar formation after stereotactic vacuum-assisted core biopsy of benign breast lesions. Clin Radiol. 61:619-24, 2006
Gombos EC et al: Collagen plug metallic marker clip: mammographic and histopathologic appearance. Breast J. 11(4):292-3, 2005
Perlet C et al: [Clip marker placement following MR-guided vacuum biopsy of the breast] Radiologe. 45(3):230-6, 2005
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
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
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
Rausch D et al: Appearance and artifacts of breast biopsy marking clips. RSNA Educational Exhibit, 2003
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
Kass R et al: Clip migration in stereotactic biopsy. Am J Surg. 184(4):325-31, 2002
Philpotts LE et al: Clip migration after 11-gauge vacuum-assisted stereotactic biopsy: case report. Radiology. 222(3):794-6, 2002
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
Rosen EL et al: Metallic clip deployment during stereotactic breast biopsy: retrospective analysis. Radiology. 218(2):510-6, 2001
DiPiro PJ: Disappearance of a localizing clip placed after stereotactic core biopsy of the breast. AJR Am J Roentgenol. 173(4):1134, 1999
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