Background: Needle localization breast biopsy (NLBB) is the standard for removal of breast lesions after vacuum assisted core biopsy (VACB). Disadvantages include a miss rate of 0% to 22%, a positive margin rate of approximately 50%, and vasovagal reactions (approximately 20%). We hypothesized that clip migration after VACB is clinically significant and may contribute to the positive margin rates seen after NLBB.
Methods: We performed a retrospective review of postbiopsy films in patients who had undergone VACB with stereotactic clip placement for abnormal mammograms. We measured the distance between the clip and the biopsy site in standard two view mammograms. The location of the biopsy air pocket was confirmed using the prebiopsy calcification site. The Pythagorean Theorem was used to calculate the distance the clip moved within the breast. Pathology reports on NLBB or intraoperative hematoma-directed ultrasound-guided breast biopsy (HUG, which localizes by US the VACB site) were reviewed to assess margin status.
Results: In all, 165 postbiopsy mammograms on patients who had VACB with clip placement were reviewed. In 93 evaluable cases, the mean distance the clip moved was 13.5 mm +/- 1.6 mm, SEM (95% CI = 10.3 mm to 16.7 mm). Range of migration was 0 to 78.3 mm. The median was 9.5 mm. In 21.5% of patients the clip was more than 20 mm from the targeted site. Migration of the clip did not change with the age of the patient, the size of the breast or location within the breast. In the subgroup of patients with cancer, margin positivity (including those with close margins) after NLBB was 60% versus 0% in the HUG group.
Conclusions: Significant clip migration after VACB may contribute to the high positive margin status of standard NLBBs. Surgeons cannot rely on needle localization of the clip alone and must be cognizant of potential clip migration. HUG as an alternative biopsy technique after VACB eliminates operator dependency on clip location and may have superior results in margin status.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/s0002-9610(02)00952-2 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Hybrid Endoscopic Thoracic Discectomy Using Robotic Arm and Navigation for Highly Migrated Calcified Disc Herniation.
Neurospine
December 2024
Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
This video provides a step-by-step guide for performing the hybrid endoscopic thoracic discectomy using navigation and robotic arm for addressing high migrated calcified disc herniation. With the development of techniques, endoscopic spine surgery has emerged as a reliable treatment for thoracic myelopathy. This approach offers high-resolution, off-axis visualization of the surgical field.
View Article and Find Full Text PDFMigration of a ureteral stent made from a nasogastric tube into the inferior vena cava: A case report.
Int J Surg Case Rep
January 2025
School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Introduction: This case report presents a rare instance of a ureteral stent, fashioned from a nasogastric tube, migrating into the inferior vena cava (IVC). The report underscores the importance of timely diagnosis and intervention to prevent severe complications.
Presentation Of Case: A 38-year-old woman presented with a ureteral stent, made from a nasogastric tube, found in the IVC following a previous surgery.
Migration of a Surgical Clip Into the Common Bile Duct and Its Spontaneous Passage.
Cureus
December 2024
General Surgery, Sunshine Coast University Hospital, Birtinya, AUS.
Cholecystectomy is one of the most commonly performed surgical operations worldwide. A rare complication following this procedure is the migration of surgical clips used to secure the cystic duct and artery. Herein, we report the migration of a metallic surgical clip into the common bile duct of a 75-year-old gentleman who underwent a laparoscopic cholecystectomy 24 years prior.
View Article and Find Full Text PDFClip and Blue-An Easy and Cost-Effective Prechemotherapy Localization Technique in Patients With Breast Cancer Planned for Breast Conservation.
JCO Glob Oncol
November 2024
Department of Surgical Oncology, Rajagiri Cancer Centre, Rajagiri Hospital, Kochi, India.
Purpose: Breast conservation after systemic therapy requires accurate localization of the lesion and its margins, especially in nonpalpable tumors. The present study aims to describe a cost-effective technique of tumor localization using the combination of surgical clips and methylene blue.
Methods: A minimum of three or four clips were inserted into the tumor to allow easy visualization of the clip mass.
Insights From ISASS Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery | Part 3: A Polytomous Rasch Analysis on Surgeons' Endorsement of Multiportal Access, Treatment of Lumbar Facet Cyst, Grade I Spondylolisthesis, and Interbody Fusion.
Int J Spine Surg
November 2024
Advanced Orthopedics, Altamonte Springs, Orlando College of Osteopathic Medicine, Orlando, FL, USA.
Background: The International Society for the Advancement of Spine Surgery hosted the third in a series of webinars focused on innovative endoscopic spine surgery techniques. This session aimed to discuss and evaluate advanced treatments for lumbar spinal stenosis and related conditions utilizing multiportal endoscopic approaches; articulating instruments; unilateral biportal endoscopy; transforaminal techniques for facet cysts, herniated disc, and spinal stenosis; as well as percutaneous endoscopic lumbar interbody fusion (PELIF).
Objective: To analyze the level of surgeon endorsement for the presented endoscopic spine surgery techniques before and after the webinar, utilizing polytomous Rasch analysis, and to evaluate the potential for these insights to inform clinical guideline recommendations.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!